Browsing by Author "Ahn, Junho"
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Item Comparing PROMIS-29 to SF-12 in Evaluating Quality of Life in Patients with Diabetes-Related Foot Disease(2020-05-01T05:00:00.000Z) Ahn, Junho; Wukich, Dane K.; Raspovic, Katherine M.; Liu, George T.BACKGROUND: With the increasing prevalence of diabetes mellitus (DM), DM-related foot disease (DFD) is an underappreciated problem with far-reaching consequences. Understanding the impact of DFD on clinical outcomes and patient-reported quality of life (QOL) is an important step for improving patient care. Historically, the 12-item Short Form (SF-12) has been commonly used to evaluate QOL in this population. However, with recent innovations in survey methods such as in the Patient-Reported Outcomes Measurement Information System (PROMIS) and computer adaptive testing (CAT), these emerging surveys should be evaluated and compared to the legacy surveys for effectiveness in measuring patient QOL. OBJECTIVE: The aim of this research was to describe patient-reported quality of life in those with and without DFD using the SF-12 and the PROMIS-29. METHODS: All patients included in the study were treated in a foot and ankle clinic in a tertiary care hospital and completed both the SF-12 and the PROMIS surveys. Patients who did not complete both surveys during the same clinic visit were not included. Patient-reported QOL was compared statistically between those with and without DFD. RESULTS: One-hundred fifty patients were included in the study. Seventy-two (48%) had DFD. Between groups, those with DFD were younger, more often male, and had poorer DM-related parameters. Patient responses on the SF-12 and PROMIS surveys correlated significantly on most parameters including SF-12 mental component summary (MCS-12) and PROMIS Depression and Anxiety subscales as well as SF-12 physical component summary (PCS-12) and PROMIS physical function. However, when evaluating ceiling and floor effects, the PROMIS survey was found to have a longer ceiling effect in patients with DFD than the SF-12. CONCLUSION: The PROMIS survey correlates well with the legacy standard, SF-12, for patient-reported QOL in those with and without DFD. In addition, the PROMIS survey may be less sensitive to ceiling effects correlated with the effects of DFD on physical and mental health, potentially being a more effective tool than SF-12 for long-term monitoring of patient QOL. In addition, the technologic advance of CAT in surveys, the patient burden of repeated survey evaluation may be diminished.Item Deep Venous Thrombosis and Pulmonary Embolism after Lower Extremity Amputation in Patients with Diabetes(2018-01-23) Gallaway, Kathryn E.; Ahn, Junho; Raspovic, Katherine M.; Wukich, Dane K.This study aims to identify risk factors for deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients with diabetes mellitus (DM) undergoing a lower extremity amputation (LEA). A retrospective analysis of 36,445 LEA cases from the American College of Surgeons-National Surgical Quality Improvement Program (ACSNSQIP) database was performed. 23,380 patients with DM and 13,065 patients without DM were evaluated to determine whether DM is correlated with an increased risk of DVT and PE. Specific risk factors for DVT and PE in this population were also evaluated. The incidence of DVT in post-LEA patients with DM was 0.94% compared to 1.36% in patients without DM (p=0.0002). The incidence of PE in patients with DM was 0.37% compared to 0.54% in patients without DM (p<0.0001). Although statistically significant, this small increase in DVT/PE risk appears to be driven by a higher proportion of "completely dependent" patients without DM (p<0.0001). Patients with "completely dependent" pre-op functional status were 2.59 times more likely to develop a DVT (95% CI: 1.81-3.70) and 3.36 times more likely to experience a PE (95% CI: 1.97-5.72), while "independent" patients were significantly less likely to experience either complication. Level of amputation (LOA) was also associated with an increased risk of DVT and PE. Patients who underwent a below knee amputation (BKA) were 2.12 times more likely to experience a DVT/PE (95% CI: 1.40-3.12) and patients with an above knee amputation (AKA) were 1.82 times more likely to experience a DVT/PE (95% CI: 1.40-3.21). Patients who underwent a transmetatarsal amputation (TMA) were significantly less likely to experience either complication. Other statistically significant risk factors identified in this study include prior myocardial infarction, ASA classification of III-V, and female sex. Patients with a history of dialysis within 2 weeks of surgery had an increased risk of DVT (OR: 1.52, 95% CI: 1.15-2.02); however, no increased risk of DVT/PE in patients with Chronic Kidney Disease (CKD) stage III-V was found (OR: 1.19, 95% CI: 0.97, 1.45). Although DM is not associated with increased risk of DVT/PE, LOA is a significant predictor of DVT/PE risk. Diabetics with peripheral neuropathy may delay seeking treatment due to lack of pain, potentially resulting in higher LOA. Physicians should emphasize rapid evaluation and management of pressure sores to minimize LOA. Prophylactic antithrombotic protocols should also be considered for patients undergoing a high level amputation and for patients with comorbid risk factors such as cardiovascular disease or dependent functional status.Item Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus(2018-01-23) Liu, Jennifer W.; Ahn, Junho; Wukich, DaneBACKGROUND: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus is associated with a myriad of complications - including infection, malunion, and impaired wound healing - following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with diabetes. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. METHODS: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with diabetes and 15,420 patients without diabetes. Odds ratios (OR) with a 95% confidence interval (CI) were calculated for each parameter. RESULTS: Out of 17,464 patients that underwent ORIF for ankle fractures, the mean age was 47.9 +/- 17.7 years, obesity (BMI ≥30 kg/m²) was documented in 38.6% of cases, and diabetes that was severe enough to require oral, non-insulin, or insulin therapy was documented in 11.7% of cases. We found that patients with diabetes mellitus had a 2.87 times increased risk of unplanned readmission (OR, 2.87; 95% CI, 2.07-6.23; p = 0.0001) and 3.30 increased risk of unplanned reoperation (OR, 3.30; 95% CI, 2.35-7.54; p = 0.0001) related to the principal operative procedure. Additionally, patients with diabetes had a 2.01 increased risk of mortality (OR, 2.01; 95% CI, 1.08-3.62; p = 0.0377) within 30 days post operation. CONCLUSIONS: Presence of diabetes mellitus increases the risk of unplanned readmission, unplanned reoperation, and mortality after ankle fracture ORIF. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complications and readmission. Large clinical databases including ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.Item Transitibial Amputations in Patients with Diabetes with and without End-Stage Renal Disease(2017-01-17) Ahn, Junho; Wukich, Dane; Raspovic, Katherine M.; La Fontaine, Javier; Lavery, Larry K.Patients with long-standing diabetes are at higher risk for developing foot ulcers, chronic foot infections, and non-salvageable deformities. Transtibial lower-extremity amputations (LEA) are commonly performed among patients with diabetes who present with foot disease and are not candidates for limb salvage. The purpose of this retrospective study was to (1) report on a consecutive series of 102 diabetic patients who underwent transtibial LEA, (2) compare outcomes of LEA patients based on presence of end-stage renal disease (ESRD) and (3) identify risk factors for mortality after LEA procedure. Medical records of 102 patients treated by a single surgeon between April 1, 2006 and January 1, 2016 were retrospectively reviewed. Patients were categorized into groups of those who did not have ESRD, and those that did have ESRD. In the study population, 21 patients (21%) were identified as having ESRD opposed to 81 patients (79%) who did not. The median patient age was 56 years and the median time to final follow-up was 109 weeks. Osteomyelitis was a common finding in the study population with a prevalence of 87.3% (89 patients), but gangrene was present in only 15.7% (16 patients). Thirty-three of 97 patients (34.0%) had contralateral foot problems, and 10 patients (10.3%) underwent contralateral amputation. Patients with ESRD had significantly greater duration of diabetes, lower HbA1c, lower hemoglobin, and increased creatinine compared to patients who did not have ESRD. Furthermore, patients with ESRD had significantly greater rates of follow-up contralateral limb amputation and overall mortality. Rate of post-operative ambulation was also significantly lower in the ESRD group. Cox proportional hazards models demonstrated that patients who were not able to ambulate post-operatively, had ESRD, and were greater than 56 years of age had significantly increased hazard of dying. The present study demonstrates that 43% of patients who were not ambulatory pre-operatively were successfully able to ambulate with prosthesis after transtibial LEA. Although one-third of patients had wound issues, only 4% of patients required reoperation. Contralateral foot problems occurred in approximately one third of patients, and 10% required subsequent contralateral LEA. The calculated 5-year survival rate was approximately 55%. Significant risk factors for mortality included ESRD, age ≥ 56 and inability to ambulate after LEA.