The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot
Hüseyin Gökhan Karahan1
, Onur Çetin2, Murat Gök2, Hasan Furkan Akın3, Abdurrahman Vural1, Cemil Kayalı3
1Sports Traumatology, Arthroscopy, Shoulder and Elbow Surgery, Istanbul Basaksehir Pine and Sakura City Training and Research Hospital, Istanbul, Türkiye
2Department of Orthopedics and Traumatology, Abdulkadir Yüksel State Hospital, Gaziantep, Türkiye
3Department of Orthopedics and Traumatology, Bozyaka Training and Research Hospital, Izmir, Türkiye
Keywords: Amputation, diabetes mellitus, diabetic foot ulcer, diabetes-related complications.
Abstract
Objectives: The aim of this study was to evaluate the factors that influenced one-year and five-year mortality and to compare major and minor amputations in diabetic patients with comorbidities.
Patients and methods: Between February 2008 and November 2014, a total of 201 type 2 diabetic foot patients (147 males, 54 females; median age: 65.99 years; range, 50 to 92 years) who underwent amputation were retrospectively analyzed. The patients were divided into two groups according to their initial amputation level: Group 1 (n=100), minor amputation group, which included the distal region of the ankle joint and Group 2 (n=101), major amputation group, which included trans-tibial amputation, trans-femoral amputation and hip disarticulation. Clinical data including patients' demographic features, re-amputation degree, length of hospitalization, hyperbaric oxygen therapy, comorbidities, blood parameters, and survival rates were recorded.
Results: The regression analysis of one-year mortality found that the presence of cerebrovascular disease increased death by 2.463 times (p=0.002). Minor amputation increased mortality by 2.284 (p=0.006), and each unit increase in patient age increased mortality by 1.05 (p=0.008). Chronic renal failure increased death by 3.164 times (p<0.001) in the five-year mortality regression analysis.
Conclusion: Minor amputations have an effect on one-year mortality, as do cerebrovascular disease and age. On the other hand, chronic renal failure has a negative impact on five-year mortality. Minor amputations may have a detrimental effect on mortality due to the ongoing progression of diabetic foot disease and the involvement of comorbidities. Comorbidities associated with amputations of the diabetic foot have a significant impact on mortality.
Citation: Karahan HG, Çetin O, Gök M, Akın HF, Vural A, Kayalı C. The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot. Jt Dis Relat Surg 2023;34(1):115-120. doi: 10.52312/jdrs.2023.818
The study protocol was approved by the Health Sciences University Izmir Bozyaka Training and Research Hospital Clinical Research Ethics Committee (date: 22.09.2021, no: 2021/163). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Data Sharing Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Each author has participated in the design of the study, has contributed to the collection of the data, has participated in the interpretation of the results and writing of the manuscript, and assumes full responsibility for the content of the manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.