The frequency and Risk Factors of Re-amputation in Diabetic Foot Disease at a tertiary care hospital.

Abstract

Introduction: The prevalence of diabetes in Pakistan is 11.7% and the preva-lence of diabetic foot in Pakistan is 13.9% with amputation rate of as high as 48%. Re-amputation carries significant morbidity in form of economic im-pact. Like most re-operations, it reflects failure of previous surgery and thus translates into wastage of resources.Objective: To determine the frequency and associated risk factors of re-amputation, in patients who undergo amputation secondary to diabetic foot syndrome in our population.Methodology: This study was conducted at the Department of Surgery De-partment of Surgery, and Diabetic Clinic Ruth Pfau Civil Hospital Karachi, from August 2020 to July 2021, after approval of ethical review board. We enrolled a total of 125 patients in our study. Data was entered and analyzed using SPSS version 22.0. Mean ±SD/ Median (IQR) was computed for age, HbA1C, duration of diabetes, duration of symptoms leading to amputation, ulcer size, ankle-brachial index and duration of re-amputation. Frequency and percentage were computed for all the categorical variables like gender, co-morbid, type of diabetes, diabetic neuropathy, morphology of diabetic foot ulcer, indication of amputation, peripheral arterial disease, level of am-putation, indication of re-amputation, and level of re-amputation.Result: Among enrolled 125 patients, 85 patients (68%) were male and 40 patients (32%) were females. Mean age was 48.75 ±9.702years. Mean dura-tion of diabetes was 11.12 ±6.64 years and mean HbA1C was 8.246 ±1.1357. During study period 61(48.8%) patients required re-amputation. Mean ABPI in patient requiring re amputation is 0.790 ±0.2501(p=0.000).Conclusion: Patients at risk of re-amputation may be identify by focusing upon good evaluation that includes assessing additional risk factors and deciding initial level of amputation. It is important to have enhance in-formed consent in avoiding the morbidity of additional surgery.Key words: Diabetic foot disease. Amputation, Re amputation.