Changes in Level of Lower Extremity Amputation and Re-amputation Rate in Diabetic Patients

Abstract

Objective: To examine the time-dependent changes in the incidence of major amputation and re-amputation in diabetic patients who underwent lower extremity amputation (LEA).

Method: We recruited 188 consecutive patients who underwent LEA due to diabetic foot ulcers at the foot care unit in the Diabetes Center of Tokyo Women's Medical University Hospital between 1993 and 2016. Patients were classified into three groups according to the amputation date: group 1: 1993-2000 (n=37), group 2: 2001-2008 (n=64) and group 3: 2009-2016 (n=87). Major amputation was defined as an amputation above the ankle, and re-amputation was defined as LEA of the same limb within 6 months after the first LEA. The time-dependent changes in each group were compared by Jonckheere-Terpstra test.

Result: The ratio of the major amputation at the final LEA during each group were 81.1 % in group 1, 70.3 % in group 2 and 34.5 % in group 3, and it was significantly reduced over time (p for trend < 0.001). The ratio of the re-amputations during each group were 29.7 % in group 1, 26.6 % in group 2 and 33.3 % in group 3, and there were not any significant difference between 3 groups (p for trend = 0.510). As for the re-amputation parts of re-amputation patients, major amputations were performed 90.9 % in group 1, 82.4 % in group 2 and 41.4 % in group 3, and it was significantly reduced over time (p for trend = 0.001).

Conclusion: The incidence of major amputation in the diabetic patient who underwent LEA was reduced over time. Although there were not any significant change with the incidence of re-amputation, but the incidence of major amputation at the re-amputation parts was reduced.