Risk assessment of amputation in patients with diabetic foot

Abstract

The prevalence of diabetes has increased dramatically over the past decade, especially in developing countries, reaching pandemic proportions. Although has been the most important factor influencing the prevalence of type 2 diabetes, the prevalence of type 2 diabetes is on the increase among younger adults. The subsequent rate of increase with age is variable, which is more evident in societies where the general prevalence of the disease is higher. Based on clinical and statistical data obtained from the patients who were admitted to The First and Second Surgery Wards in the Sibiu County Emergency University Clinical Hospital (Sibiu, Romania) and the Proctoven Clinic (Sibiu, Romania) between January 2018 and December 2020, the present study attempted to devise a risk score that can be applied for the benefit of patients. The ultimate aim was that this risk score may be eventually applied by diabetologists and surgeons to assess the risk of amputation in patients with diabetic foot lesions. An important part in the therapeutic management of diabetic foot injuries is the assessment of risk factors. Using this risk score system devised, the risk factors that were found to exert influence in aggravating diabetic foot injuries are smoking, obesity, dyslipidaemia, unbalanced diabetes mellitus (glycated haemoglobin ≥7.5%), duration of diabetes >5 years, hepatic steatosis and the co-existence of various heart diseases. To conclude, all these risk factors aforementioned can decrease the effectiveness of treatment and can have a significant impact on the quality of life, if they are not well known.

Keywords: amputation; diabetic foot; risk factors.

Figure 1

Distribution of patients according to impairment. Unilateral involvement of the lower limbs was more frequent, representing 78% of all patients compared to 22% of the group that had bilateral lesions.

Figure 2

Distribution of the number of patients according to the identified comorbidities. On the X-axis, the comorbidities analyzed in the study are illustrated, whereas on the Y-axis, the number of cases associated with the studied comorbidities is highlighted. The most frequent comorbidities were HBP, COA and CIHD. HBP, high blood pressure; CIHD, chronic ishemic heart disease; HF, heart failure; CKF, chronic kidney failure; CVI, chronic venous insufficiency; COA, chronic obliterative arteriopathy; COPD, chronic obstructive pulmonary disease.

Figure 3

Percentage distribution of types of surgery as a result of diabetic foot. It can be observed that amputation and debridement together represent 66% of the total surgical procedures in the diabetic foot. Necrectomy, disarticulation and by-pass of the lower limb represent together represent only 34% of the performed surgical procedures.

Figure 4

Incidence of patients that required amputation by age group. On the ‘X-axis, the age groups of the patients included in the study are illustrated, and on the Y-axis, the number of amputations performed. There is an increased incidence of the number of amputations in the 60-70 years age group, followed by the 70-80 years age group.