Background:
We hypothesized that perioperative HbA1c influenced the pattern and outcomes
of Lower Extremity Amputation (LEA).
Methods:
A retrospective analysis was conducted for all patients who underwent LEA between 2000
and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group
1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We
identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1:
18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was
performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively.
Results:
The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization.
Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%,
respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had
lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI
0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant.
The rate of LEA was greater among poor glycemic control patients; however, the mortality
was higher among patients with tight control.
Conclusion:
The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic
implications need further investigation.
Preliminary Analysis of Negative Pressure to Prevent Lower Extremity Amputation Wound Complications: Pilot Data From a Randomized Clinical Trial