The phantom paradox: Protective and risk factors for phantom limb pain following major lower extremity amputation.

High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease

Major lower extremity amputation (LEA) such as below-knee or above-knee amputations can result in more physical disabilities and poorer socioeconomic functions than minor LEAs in diabetic foot ulcer (DFU). Therefore, identification of risk factors for major LEA and investigation of effectiveness of endovascular revascularization are critical for prevention and better prognosis of DFU patients. From January 2014 to December 2017, a total of 125 patients with DFU treated with any level of amputation were included in this study. Demographic, diabetes-related, DFU-related and -relevant laboratory information were investigated to predict major amputation. To identify risk factors for major amputation, logistic regression analysis was performed for each variable. The effectiveness of endovascular revascularization treatment was analyzed using Kaplan-Meier survival curves. Major amputation was performed for 22 of 125 patients. Multivariate logistic regression analysis indicated that DM duration, peripheral arterial occlusive disease (PAOD) previous amputation, abscess, Wagner grade, CRP and albumin were significant risk factors for major amputation in DFU patients. PAOD was the most important risk factor. Major amputation-free survival rate at 5years was 97.4% in a non-PAOD group, 58.3% in a PAOD without revascularization group, and 88.0% in a PAOD with revascularization group, showing statistically significant differences among them. The duration of DM, PAOD, previous amputation, abscess, Wagner grade, CRP and albumin were major risk factors for major LEA in DFU patients. The most valuable and critical finding was that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates.

Category: Diabetes; Other Introduction/Purpose: Diabetic foot wound (DFW) is a relatively common diabetic complication and the leading cause of lower extremity amputation (LEA). Major LEA, such as below-knee or above knee amputations result in more physical disabilities and poorer socioeconomic functions than minor LEA, such as foot and phalangeal amputations. Peripheral arterial occlusive disease (PAOD) considered an important predictor of overall outcomes of DFW. The identification of risk factors for major LEA and investigation of effectiveness of revascularization treatment are critical for prevention and better prognosis of DFW patients. Methods: From January 2014 to December 2019, the study includes a total of 125 patients with DFW treated with any level of amputation. Demographic, diabetes-related, DFW related and relevant laboratory information were investigated to predict major amputation. To identify the risk factor for major amputation, logistic regression analysis was performed for each variable. The effectiveness of revascularization treatment was analyzed by Kaplan-Meier survival curves. Results: Multivariate logistic regression analysis indicated that DM duration (OR, 1.173; 95% CI, 1.073~1.282; p=0.001), PAOD (OR, 22,563; 95% CI, 2.270~93.282; p=0.008), previous amputation (OR, 8.460; 95% CI, 2.369~30.203; p=0.001), abscess (OR, 4.703; 95% CI, 1.275~17.341; p=0.020), Wagner classification grade (OR, 9.349; 95% CI, 2.512~34.794; p=0.001), CRP (OR, 1.143; 95% CI, 1.058~1.235; p=0.001) and albumin (OR, 0.344; 95% CI, 0.129~0.917; p=0.033) were significant risk factors in DFW patients. The major amputation free survival rate at 5 years was 97.4% in non-PAOD group, 49.0% in PAOD with non-revascularization group and 79.0% in PAOD with revascularization group. Moreover, there was statistically significant difference (p=0.001) Conclusion: Among various potential risk factors, the study results concluded that duration of DM, PAOD, previous history of amputation, presence of Abscess, Wagner grade (greater than 3), and such laboratory markers as CRP and albumin, are major risk factors predictive of major LEA in DFW patients. The most valuable and critical finding from the current study is that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates.

IP215. Population-Based Secular Trends in Lower Extremity Amputations for Diabetes and Peripheral Artery Disease

BackgroundRates of major lower extremity amputation in patients with peripheral artery disease are higher in rural communities with markers of low socioeconomic status, but most Americans live in metropolitan areas. Whether amputation rates vary within US metropolitan areas is unclear, as are characteristics of high amputation rate urban communities.Methods and ResultsWe estimated rates of major lower extremity amputation per 100 000 Medicare beneficiaries between 2010 and 2018 at the ZIP code level among ZIP codes with ≥100 beneficiaries. We described demographic characteristics of high and low amputation ZIP codes, and the association between major amputation rate and 3 ZIP code–level markers of socioeconomic status—the proportion of patients with dual eligibility for Medicaid, median household income, and Distressed Communities Index score—for metropolitan, micropolitan, and rural ZIP code cohorts. Between 2010 and 2018, 188 995 Medicare fee‐for‐service patients living in 31 391 ZIP codes with ≥100 beneficiaries had a major lower extremity amputation. The median (interquartile range) ZIP code–level number of amputations per 100 000 beneficiaries was 262 (75–469). Though nonmetropolitan ZIP codes had higher rates of major amputation than metropolitan areas, 78.2% of patients undergoing major amputation lived in metropolitan areas. Compared with ZIP codes with lower amputation rates, top quartile amputation rate ZIP codes had a greater proportion of Black residents (4.4% versus 17.5%, P<0.001). In metropolitan areas, after adjusting for clinical comorbidities and demographics, every $10 000 lower median household income was associated with a 4.4% (95% CI, 3.9–4.8) higher amputation rate, and a 10‐point higher Distressed Communities Index score was associated with a 3.8% (95% CI, 3.4%–4.2%) higher amputation rate; there was no association between the proportion of patients eligible for Medicaid and amputation rate. These findings were comparable to the associations identified across all ZIP codes.ConclusionsIn metropolitan areas, where most individuals undergoing lower extremity amputation live, markers of lower socioeconomic status and Black race were associated with higher rates of major lower extremity amputation. Development of community‐based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.

BackgroundWe examined trends in incidence (2001–2019), clinical characteristics, and in-hospital outcomes following major and minor lower extremity amputations (LEAs) among type 1 diabetes mellitus (T1DM) patients in Spain and attempted to identify sex differences.MethodsRetrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of the LEA procedure stratified by type of LEA. Joinpoint regression was used to estimate incidence trends, and logistic regression was used to estimate factors associated with in-hospital mortality (IHM).ResultsLEA was coded in 6011 patients with T1DM (66.4% minor and 33.6% major). The incidence of minor LEA decreased by 9.55% per year from 2001 to 2009 and then increased by 1.50% per year, although not significantly, through 2019. The incidence of major LEA decreased by 13.39% per year from 2001 to 2010 and then remained stable through 2019. However, incidence increased in men (26.53% per year), although not significantly, from 2017 to 2019. The adjusted incidence of minor and major LEA was higher in men than in women (IRR 3.01 [95% CI 2.64–3.36] and IRR 1.85 [95% CI 1.31–2.38], respectively). Over the entire period, for those who underwent a minor LEA, the IHM was 1.58% (2.28% for females and 1.36% for males; p = 0.045) and for a major LEA the IHM was 8.57% (10.52% for females and 7.59% for males; p = 0.025).IHM after minor and major LEA increased with age and the presence of comorbid conditions such as peripheral arterial disease, ischemic heart disease or chronic kidney disease. Female sex was associated with a higher IHM after major LEA (OR 1.37 [95% CI 1.01–1.84]).ConclusionsOur data show a decrease in incidence rates for minor and major LEA in men and women with T1DM and a slight, albeit insignificant, increase in major LEA in men with T1DM in the last two years of the study. The incidence of minor and major LEA was higher in men than in women. Female sex is a predictor of IHM in patients with T1DM following major LEA.

Reamputation after Minor Foot Amputation in Diabetic Patients: Risk Factors Leading to Limb Loss

Failed grafts and level of amputation

BackgroundMortality rates between minor (e.g., removal of toes or part of the foot) and major (e.g., below- or above-the-knee) lower extremity amputations (LEA) vary significantly in diabetic patients. Other factors, including survival rates, rehabilitation outcomes, and healthcare burden, are also notably impacted by the type of amputation performed.ObjectiveThis narrative review aims to analyze and compare mortality rates following minor and major LEA in diabetic patients, by highlighting key risk factors and their impact on patient outcomes.MethodsA narrative review of existing literature was conducted by using searches of PubMed and Google Scholar. Studies reporting mortality rates, risk factors, comorbidities, functional outcomes, and management strategies among diabetic patients undergoing minor and major LEA were included.ResultsMajor LEA is associated with significantly higher short- and long-term mortality rates, with five-year survival ranging from 10% to 48%, compared to 29% to 69% for minor LEA. The key risk factors for mortality include chronic renal disease, peripheral arterial disease, sepsis, and poor glycemic control. While minor LEA offers better survival rates, it carries a higher risk of progression to major amputation if diabetes-related complications persist.ConclusionThe findings highlight the critical importance of early intervention, strict glycemic control, and multidisciplinary care to improve the survival and quality of life in diabetic patients undergoing LEA. Limb preservation strategies should be prioritised whenever possible, as minor amputations lead to better long-term outcomes. Future research should focus on refining risk stratification and optimizing rehabilitation programs to enhance patient prognosis post-amputation.

The Majority of Patients Have Diagnostic Evaluation Prior to Major Lower Extremity Amputation

Complications of Charcot Reconstruction in Patients With Peripheral Arterial Disease

Syme Amputation for Limb Salvage: Early Experience with 26 Cases

Multidisciplinary limb salvage care is associated with decreased mortality without increasing revascularization in major amputations.

Risk Factors for Unplanned Readmission and Stump Complications After Major Lower Extremity Amputation

Risk Factors for Unplanned Readmission and Stump Complications following Major Lower Extremity Amputation