Amputation rate in 147 Turkish patients with diabetic foot: the Hacettepe University Hospital experience

Abstract

To determine the lower extremity amputation rate and the risk factors for amputation, we analysed the medical records of 147 Turkish diabetic patients who have been referred to the clinic with diabetic foot. Eleven patients (7.5%) had type 1, and 136 patients (92.5%) had type 2 diabetes mellitus. Fifty-four patients (36.7%) have undergone amputation due to diabetic foot. Femoropopliteal by-pass has been performed in 4 patients in the non-amputees group who did not have gangrene. None of the patients in the amputees group has undergone a revascularisation procedure. Considering all lower-extremity amputations in the group studied, 25.9% were transphalangial amputations, 3.7% were transmetatarsal amputations, 7.4% were Syme type amputations, 51.9% were below-knee amputations, and 11.1% were above-knee amputations. In a logistic regression model, age, gender, duration of diabetes, smoking history, hypertension, retinopathy, nephropathy, and peripheral neuropathy were insignificant factors in determining the risk of amputation. In contrast, presence of peripheral vascular disease (odds ratio 4.0, 95% CI 1.17-13.4; p = 0.03), osteomyelitis (odds ratio 3.73, 95% CI 1.08-12.6; p = 0.04) and gangrene (odds ratio 30.8, 95% CI 7.39-121.5; p < 0.0001) were found to be the significant predictors of amputation. The mortality rate due to amputation during hospital stay was 13.2%. These data suggest that lower extremity amputation is a frequently encountered outcome of the hospitalized patients in Turkish diabetic population with diabetic foot which mainly occur due to peripheral vascular disease, osteomyelitis and gangrene. Lack of adequate vascularisation procedures might have contributed to a high percentage of major amputations in the group studied. Population-based studies should be undertaken in order to determine the status of lower extremity amputation as a whole in Turkish diabetic population.