A Study of Factors Influencing Major and Minor Amputations in Patients of Diabetic Foot Disease in a Tertiary Care Hospital in Eastern India

Abstract

Background: The factors leading to amputation in diabetic foot ulcer are diabetic neuropathy, bony deformities, inconspicuous trauma, and vascular diseases, uncontrolled diabetes for long duration, no use of foot wear, low educational status and poor nutritional state. We aimed at finding the major determinants leading to major and minor amputation in diabetic foot cases in a tertiary care institute. Methods: A prospective observational study was done in the General Surgery department of our institute from July 2018 - October 2019. The aim of our study is to determine the various factors that are influencing major and minor amputation in Diabetic foot disease. Findings: 2268 patients fulfilled the inclusion criteria of our study. 21 patients didn’t came for further follow up visits. Hence a total 2247 patients were studied. 1454(64.7%) patients were male. Uncontrolled diabetes [Random Blood Sugar (RBS)>200mg %] was the most common factor leading to amputation [Relative Risk=5.10: 95% Confidence Interval=4.73-5.47]. Bare foot walking with a Relative risk (RR) of 4.98 was the second most common cause. Neuropathy and hypoalbuminemia were the other significant predictors with RR=3.71 and RR=3.67 respectively. Interpretation: We conclude uncontrolled diabetes (RBS>200mg %), not using foot wear, neuropathy, hypoalbuminemia are the five most significant predictors leading to amputation of the limb in diabetic ulcers in the respective order. The risks of amputation are also high in patients with diabetes for more than 10 years, presence of arterial insufficiency & in patients with low educational status. Funding Statement: No funding received for the study. Declaration of Interests: We have nothing to declare and we have no conflicts of interest. Ethics Approval Statement: The study was approved by the institutional ethics committee vide IEC/IRB no: 996/14.10.2019.