scholarly journals Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures: Evidence from a cohort of a half-million diabetic patients

Diabetes Care ◽  
2006 ◽  
Vol 29 (11) ◽  
pp. 2409-2414 ◽  
Author(s):  
H.-F. Chen ◽  
C.-A. Ho ◽  
C.-Y. Li
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Revascularization Procedures ◽  
Extremity Amputation ◽  
Age And Sex

scholarly journals Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections

2017 ◽  
Vol 4 ◽  
pp. 233339281772110 ◽  
Author(s):  
Andrea L. Lorden ◽  
Luohua Jiang ◽  
Tiffany A. Radcliff ◽  
Kathleen A. Kelly ◽  
Robert L. Ohsfeldt
Keyword(s):  
Clostridium Difficile ◽  
Lower Extremity ◽  
Clostridium Difficile Infection ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Healthcare Associated Infections ◽  
Preventable Hospitalizations ◽  
Potentially Preventable Hospitalizations ◽  
Healthcare Associated ◽  
Extremity Amputation

Background: An estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs) and accounted for $9.8 (USD) billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs) may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events. Aims: To estimate the period occurrences and likelihood of acquiring an HAI for the PPH population. Methods: Retrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics. Findings: We identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91) for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant. Conclusions: Clinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements.

Amputation and reamputation of the diabetic foot

1997 ◽  
Vol 87 (6) ◽  
pp. 255-259 ◽  
Author(s):  
DG Armstrong ◽  
LA Lavery ◽  
LB Harkless ◽  
WH Van Houtum
Keyword(s):  
Lower Extremity ◽  
Previous History ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
South Texas ◽  
Diabetic Patients ◽  
Amputation Level ◽  
Causal Pathway ◽  
Peripheral Arterial ◽  
Extremity Amputation

The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations.

Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death

2017 ◽  
Vol 11 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Dane K. Wukich ◽  
Katherine M. Raspovic ◽  
Natalie C. Suder
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Lower Extremity Amputation ◽  
Controlled Study ◽  
Control Group ◽  
Diabetic Patients ◽  
Charcot Neuroarthropathy ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Extremity Amputation

Background. The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. Methods. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non–diabetes-related foot pathology. Results. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Conclusion. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Levels of Evidence: Level II: Prospective, Case controlled study

Lower Extremity Amputation in Diabetic Patients

Diabetes ◽  
1970 ◽  
Vol 19 (3) ◽  
pp. 189-195 ◽  
Author(s):  
M. L. Ecker ◽  
B. S. Jacobs
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Extremity Amputation

scholarly journals Increased Risk of Lower-Extremity Amputation Among Caucasian Diabetic Patients on Dialysis

Diabetes Care ◽  
2001 ◽  
Vol 24 (9) ◽  
pp. 1689-1690 ◽  
Author(s):  
S. Morbach ◽  
C. Quante ◽  
H. R. Ochs ◽  
F. Gaschler ◽  
J.-M. Pallast ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Extremity Amputation

Benchmark Analysis on Diabetics at High Risk For Lower Extremity Amputation

1996 ◽  
Vol 17 (11) ◽  
pp. 695-700 ◽  
Author(s):  
Michael S. Pinzur ◽  
Rodney Stuck ◽  
Ronald Sage ◽  
Lisa Pocius ◽  
Bryan Trout ◽  
...  
Keyword(s):  
High Risk ◽  
Lower Extremity ◽  
Patient Care ◽  
Lower Limb ◽  
Lower Extremity Amputation ◽  
Organ System ◽  
Limb Amputation ◽  
Diabetic Patients ◽  
Benchmark Analysis ◽  
Extremity Amputation

After the 1990 establishment of a multidisciplinary foot salvage clinic, 1346 diabetic patients, at high risk for the development of foot ulcers and eventual lower limb amputation, were followed for 4 years. Of the 224 high-risk patients admitted to the hospital, 74 amputations (5.5%) of all or part of a lower limb were performed. Patients undergoing amputation were younger, more severely ill, and required more frequent hospitalizations because of greater organ system involvement. They were also more likely to be institutionalized after discharge. Overall, patients with long-standing adult-onset diabetes, identified as at high risk for foot ulcer development, have a substantially increased risk for lower limb amputation, multiple organ system failure, hospitalization, and institutionalization than do diabetic patients as a whole. Clinical benchmarking facilitates the identification and reduction of unnecessary variations in patient care practices. Here, a formal benchmark analysis provides the current outcome expectations for amputation rates and co-morbidities in patients with diabetes who are classified as at high risk for lower extremity amputation. Management of these patients in a structured, multidisciplinary foot salvage clinic, augmentation of baseline services, and preliminary benchmark data may provide a standard for the measurement of therapeutic interventions that improve patient care.

scholarly journals NON –TRAUMATIC LOWER EXTREMITY AMPUTATIONS IN DIABETICS

2012 ◽  
Vol 19 (05) ◽  
pp. 615-619
Author(s):  
Muhammad ATEEQ ◽  
ABID BASHIR ◽  
SHAZIA JEHAN
Keyword(s):  
Lower Extremity ◽  
Teaching Hospital ◽  
Care Service ◽  
Health Care Service ◽  
Lower Extremity Amputation ◽  
Amputation Rate ◽  
Diabetic Patients ◽  
Foot Care ◽  
Cross Sectional ◽  
Extremity Amputation

Objective: The purpose of this study was to estimate the prevalence of non -traumatic lower extremity amputations in diabetic inperipheral teaching hospital catchment area. Study Design: Prospective, Cross sectional, Interventional. Setting: Surgical Unit II. Aziz BhattiShaheed (Teaching) Hospital. Nawaz Sharif medical College, University of the Gujrat. Study Period: February 1, 2011 to January 31, 2012.Results: A total of 132 patient were subjected to non traumatic lower extremity amputation were enrolled in this study out of which 89 (67.42%)were diabetic, followed by non specific infections n=39 (23.48) Out of 89 total diabetic patients 53 (40.15%) patients were female whereas 36(27.27%) were male. Both major and minor non traumatic lower extremity amputation rate was more in female diabetic patients than malediabetics. Conclusions: The prevalence of non –traumatic below knee amputations at an early age is high in our diabetic patients, especially infemale population. By improving primary health care service regarding foot care awareness in diabetics appears to be the main way to reducethe amputation rate.

SCORING SYSTEM FOR ASSESSING RISK OF AMPUTATION IN PATIENT'S WITH DIABETIC FOOT

2021 ◽  
pp. 46-48
Author(s):  
Seelam Srinivasa Reddy ◽  
Ravipati Sai Krishna ◽  
Sai Krishna Bendi ◽  
Baratam Grace Evangeline
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Scoring System ◽  
Ankle Brachial Index ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Acute Phase Reactants ◽  
Increased Risk ◽  
Peripheral Arterial Diseases ◽  
Extremity Amputation

Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Our aim is “To formulate a risk scoring system that can predict the risk of amputation in a patient with an infected diabetic foot”. Previously published studies aimed at identifying independent risk factors for lower-extremity amputation in patients with a DFI have noted an association with older age, the presence of fever, elevated acute-phase reactants, higher HbA1c levels, and renal insufciency. In the current study, we have identied that Age, Duration of diabetes, History of amputations, Ulcer depth, Ankle-brachial index, Severity of infection, and Peripheral neuropathy, Peripheral arterial diseases are signicantly associated with Lower Extremity amputation. Peripheral vascular disease and infection were the most powerful predictors, as 65% of patients who underwent amputations in our study belonged to Rutherford grade 3 and grade 4. We developed a New Risk score for predicting amputation in diabetic patients with an infected foot ulcer, which can be readily used in daily clinical practice without the necessity of extensive lab investigations. Patients with a score of >16.5 are at increased risk of lower extremity amputation. 66.6% of our follow up cases who underwent reamputations belonged to the group with a score of >16.5. Risk of amputation increases as the score increases

Predictive Laboratory Findings of Lower Extremity Amputation in Diabetic Patients: Meta-analysis

2017 ◽  
Vol 16 (4) ◽  
pp. 260-268 ◽  
Author(s):  
Jong-Lim Kim ◽  
Jin Yong Shin ◽  
Si-Gyun Roh ◽  
Suk Choo Chang ◽  
Nae-Ho Lee
Keyword(s):  
Lower Extremity ◽  
Meta Analysis ◽  
Fasting Blood Glucose ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Major Amputation ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Laboratory Findings ◽  
Extremity Amputation

Lower extremity amputation is a source of morbidity and mortality among diabetic patients. This meta-analysis aimed to identify significant laboratory data in patients with diabetic foot ulcer with high rates of lower extremity amputation. We performed a systematic literature review and meta-analysis using MEDLINE, EMBASE, and Cochrane databases. We extracted and evaluated 11 variables from the included studies based on amputation rates. This study used the Newcastle-Ottawa Scale to assess the quality of the studies. The search strategy identified 101 publications from which we selected 16 articles for review. We identified HbA1c, fasting blood glucose, white blood cells, C-reactive protein, and erythrocyte sedimentation rate as predictive variables of higher major amputation rate. Although further investigation of long-term and prospective studies is needed, we identified 5 variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.

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