Transitibial Amputations in Patients with Diabetes with and without End-Stage Renal Disease
MetadataShow full item record
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.