Outcome after Above-Knee Amputation in Diabetic Patients

Abstract

Diabetes mellitus is a common illness, which is associated with significant morbidity and mortality. The incidence of the illness is on the increase worldwide. Data indicates a 10-fold increase in amputation prevalence when comparing diabetic to non-diabetic individuals. Twenty-five to ninety percent of all amputees are diabetic patients. Lower limb amputation in diabetic patient population is associated with significant morbidity and mortality In this study we reviewed data from 61 diabetics who underwent above knee amputation at Buddhist Tzu-Chi General Hospital during the years 1994 to 2004. Patients who had above knee amputation as result of trauma and malignancy were excluded. There were 41 males and 22 females. Patient's age ranged from 45 to 97 years old. The mean age is 72 years old. Mean total hospital stay was 30 days, with a range of 6 to 162 days. A high percentage of the patients (64%) had associated co-morbid illnesses. Eighteen patients (29%) were associated with cerebrovascular incidents, 11 patients (18%) were dialysis dependent, 9 patients (15%) with hypertension and 8 patients (13%) having cardiac related illnesses. There were 10 patients who required stump revision, 7 of which was due to wound infection, 1 due to hematoma, 1 was an initial open above knee amputation and 1 due to wound dehiscence. Twenty-four of the 61 patients (39%) died during the pen-operative period. Among these 17 patients (28%) died as result of sepsis, septic shock and multiple organ failure. Five patients (8%) died of cardiac related illness and 2 patients (3%) died of pneumonia. The 1-year, 3-year and 5-year survival rate was 48%, 31% and 18% respectively. These patients most often died of their associated illnesses. The total ambulatory rate was only a mere 4 patients (6.5%) who managed to fit prosthesis and remained mobile. Diabetes mellitus is a common cause of leg amputation. A multidisciplinary team is required to retard the disease progress and prevent its complications