Risk factors for major amputation in hospitalized diabetic patients with forefoot ulcers

Abstract

Aims: The purpose of this study was to investigate the risk factors for major amputation in patients hospitalized with diabetic forefoot ulcers.

Methods: Between January 2003 and December 2018, a total of 1792 diabetic patients were admitted to the diabetic wound center for the management of diabetic foot ulcers. Among the patients, 1032 diabetic patients with forefoot ulcers were included in this study. Nine hundred and eighty-three patients (95%) healed without major amputations while 49 patients (5%) healed after major amputations. Data related to 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology, and serology were collected from the patients in these two groups for comparison.

Results: Among the 88 potential risk factors, 34 showed statistically significant differences between the two groups. In the univariate analysis of 88 risk factors, 33 showed statistically significant differences. In stepwise multiple logistic regression analysis, four of the 33 risk factors remained statistically significant. The multivariate-adjusted odds ratios for gender, magnesium levels, platelet levels, and glycated hemoglobin (HbA1c) levels were 8.216, 2.480, 1.009, and 0.570, respectively.

Conclusion: Risk factors for major amputation in patients hospitalized with diabetic forefoot ulcers include male gender, increased magnesium, increased platelet levels, and low levels of HbA1c.

Keywords: Amputation; Diabetic foot; Foot ulcer; Risk analysis; Risk factors.