Risk Factors for Major Amputation of Diabetic Foot Ulcers

Background: Diabetic foot ulcers are very common in the Philippines, accounting for 16-20% of the yearly emergency room admissions at the Philippine General Hospital. We look into the risk factors associated with major amputation of diabetic foot ulcers at the said institution. A multispecialty team, known as Diabetes Extremity Care Team (DECT), was created to address the concerns in the diabetic foot management. No data have been no reported from the Philippines. Objective: To compare the clinical and biochemical characteristics of diabetic foot ulcer patients who underwent major amputation and those who underwent minor and non-amputation and; to identify the risk factors associated with major limb amputation. Methods: Cross-sectional, analytical. A retrospective review of charts was done from 2004 to 2007 with the diagnosis of diabetic foot ulcer. There were 501 charts reviewed however nine wereexcluded due to lost pages. University of Texas was used in the classification of diabetic foot ulcers. Difference in means was tested using T-test and difference in proportions was tested using Chi Square test. Multiple logistic regression analysis was done to determine which variable was associated with major amputation. Results: Major amputation was done in 48.6% of patients which was significantly lower than the pre-DECT at 70% (p<0.001) however still above the ADA recommendation of <40%. Below knee amputation was done in 42.7%, above knee amputation at 4.7% and hip disarticulation in 1.2%. Presence of neuropathy (OR: 1.66, p0.04), peripheral vascular disease (OR: 1.27, p0.05) and ulcer severity using the University of Texas classification (OR: 2.16, p0.01) were associated with major amputation of diabetic foot ulcers. On multiple logistic regression, University of Texas 3D (OR: 2.2, p<0.01) and neuropathy (OR: 1.63, p0.02) were the predictors for major diabetic limb amputation. Conclusion: A significant proportion of diabetic foot ulcer patients at the Philippine General Hospital had major amputation. This study showed that patients with neuropathy and University ofTexas 3D classification were likely to undergo major amputation, thus the need for emphasis on adequate foot care among diabetic patients. Keywords: diabetic foot ulcers; major limb amputation Philippine Journal of Internal Medicine, Vol. 49 No. 2: Apr-Jun 2011, pp 74-78