Predictors and Risk Factors of Wound Complications in Diabetic Patients Post Lower Limb Amputation: A Prospective Study

Abstract

Abstract Background Despite advances in limb-salvage surgery, lower extremity amputation is still commonly required as an end result of the progression of arterial occlusive disease or failed arterial reconstruction. Furthermore, the increasing prevalence of diabetes has led to the appearance of more patients with foot complications leading to eventual lower extremity amputation. Objective To investigate the predictors and risk factors associated with wound complications after lower limb amputations in diabetic patients. Methods This is a prospective study, in which we follow up diabetic patients who went for lower limb amputation (AKA or BKA) and record the incidence of post operative wound complications. The study included 30 diabetic patients undergoing lower limb amputation in Ain Shams University hospitals, with postoperative follow up for 24 weeks, and the outcome measured is the incidence of post operative complication in relation to preoperative risk factors and predictors. Results Regarding the comparison between AKA and BKA it was found that patients who had BKA had higher rates of superficial SSI which were statistically significant (P < 0.05). While patients who had AKA had higher rates of pneumonia and mortality but not statistically significant (P > 0.05). Wound disruption, pulmonary embolism and MI were higher in patients who had BKA but was not statistically significant (P > 0.05). Regarding assessing predictors and risk factors for assessing post operative complications it was found that female gender, smoking and obesity (BMI >30) was statistically significant in assessing the risk factors (P value <0.05). Also regarding other predictors and risk factors of postoperative complication after the end of the study duration it was found that lower HGb levels (Anemia), Hct, ESR and CRP are considered predicators (P-value < 0.05). Other factors such as preoperative sepsis, emergency status and presence of infection were strongly related to post operative complication P-value 0.003 each (P-value < 0.05). Conclusion Surgical site infections (SSIs) following lower extremity amputations (LEAs) are a major cause of patient morbidity and mortality. The objectives of this study were to investigate the incidence of SSI and other wound complications after LEA in diabetic patients and to assess risk factors associated with SSI. This study found that below-the-knee amputation, smoking, obesity, emergency status, anemia, lower hematocrit and preoperative sepsis to be associated with SSIs.