Association of risk factors with a major re-amputation in Malaysian diabetic patients: a retrospective cohort analysis of patient registry

Abstract

This study aimed to determine the association of risk factors with a major re-amputation in Malaysian diabetes patients. This is a retrospective review and analysis of a patient cohort obtained from National Orthopedic Registry Malaysia (NORM) between June 2008 and December 2009. Re-amputation is defined as the removal of bones to advance to a higher level of amputation. An amputation can be regarded as a re-amputation if it is performed on the same limb within the same admission period and is also considered to be the final level of amputation. The plausible risk factors that are reported as importantly associated with the risk of re-amputation include patients’ baseline socio-demographic factors, clinical characteristics, and treatment outcomes, and these are analyzed both separately and together. A total of 137 patients were eligible for inclusion into the study. Only 23.4% of the total 137 patients were actually re-amputated. Baseline clinical characteristics such as the presence of neuropathy (p = 0.004), nephropathy (p = 0.005), and the topical application of emollient (p = 0.003) are found to be associated with requirement for a major re-amputation. Almost a quarter of patients who had an initial amputation will require a re-amputation. The patients who were at a particularly high risk of the need for re-amputation were those experiencing complications of diabetes such as nephropathy. Topical application of emollient is necessary to delay the need for re-amputation and if possible, avoid it altogether.