Type of publication:
Conference abstract
Author(s):
*Cane C.; *Beard N.; *Al-Samaraaie E.; *Basavaraju N.; *Moulik P.
Citation:
Diabetic Medicine. Conference: Diabetes UK Professional Conference 2024. London . 41(Supplement 1) (no pagination), 2024. Date of Publication: 01 Apr 2024.
Abstract:
Aims: Mortality following major diabetic amputation is high. We analysed data on factors leading to mortality following major amputation. Method(s): Data on all 48 major non-traumatic diabetic lower-limb amputation between April 2022 and March 2023 were analysed in September 2023. 33 (69%) were alive and 15 (31%) had died. Result(s): 90% patients had type 2 diabetes and 67% had diabetes duration>10 years. 17 (35%) were female. 38 (80%) were between 50 and 80, 9 (18%) over 80 years old. 21 (42%) were overweight or obese. 26 (54%) had below knee amputation (BKA) and 22 (46%) above knee amputation (AKA). Half were current or ex-smokers, 58% hypertensive, 79% hyperlipidaemic or on statins, 83% on antiplatelet/anticoagulants. 27 (57%) had eGFR >60 mL/min, 17 (35%) eGFR 30-60 mL/min, 4 (8%) eGFR 15-30 mL/min and none with eGFR <15 mL/min. 37% had pre-proliferative/proliferative retinopathy or maculopathy, 28 (58%) previous foot ulcers and 19 (40%) previous amputation. 80% had neuropathy and 80% peripheral arterial disease. Cause of amputation was critical ischaemia in 27 (56%), sepsis/spreading gangrene in 17 (36%). 10 patients died in hospital and 5 in the community. Cause of death was cardiorespiratory in 6 (40%), sepsis related to DFU in 2 (13%), sepsis unrelated to DFU in 3 (20%), old age/dementia in 2 (13%) and unknown in 2 (13%). Mortality was similar in BKA and AKA. Mann-Whitney test with Monte Carlo correction suggested age >40 at diagnosis of diabetes, advanced nephropathy and retinopathy additionally predicted mortality. Conclusion(s): A third of patients had died within a year following major amputation. Majority were older patients with multiple risk factors contributing both to amputation and mortality, but additional predictors of mortality were nephropathy and retinopathy.
DOI: 10.1111/dme.15296
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