scholarly journals Effects of Anesthetic Techniques on the Risk of Postoperative Complications Following Lower Extremity Amputation in Diabetes Patients with Coagulation Abnormalities: A Retrospective Cohort Study Using Propensity Score Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5598
Author(s):  
Hye Jin Kim ◽  
Chun-Gon Park ◽  
Yong Seon Choi ◽  
Yong Suk Lee ◽  
Hyun-Jeong Kwak
Keyword(s):  
Postoperative Complications ◽  
Lower Extremity ◽  
General Anesthesia ◽  
Diabetic Foot ◽  
Odds Ratio ◽  
Lower Extremity Amputation ◽  
Coagulation Abnormalities ◽  
Number Of Patients ◽  
Extremity Amputation ◽  
Diabetes Patients

Diabetic foot amputation is associated with high morbidity and mortality rates. To prevent cardiovascular complications along with vasculopathy in the course of diabetes mellitus, a high number of patients receive anticoagulant therapy. However, anticoagulants are contraindicated in neuraxial anesthesia limiting available anesthetic modalities. Therefore, in this retrospective study, we aimed to compare between general anesthesia and peripheral nerve block (PNB) with respect to postoperative complications following lower extremity amputation (LEA) in patients with coagulation abnormalities. In total, 320 adult patients who underwent LEA for diabetic foot were divided into two groups according to the anesthetic type (general anesthesia vs. PNB). The inverse probability of treatment weighting was performed to balance the baseline patient characteristics and surgical risk between the two groups. The adjusted analysis showed that compared with the general anesthesia group, the PNB group had lower risks of pneumonia (odds ratio: 0.091, 95% confidence interval [CI]: 0.010–0.850, p = 0.0355), acute kidney injury (odds ratio: 0.078, 95% CI: 0.007–0.871, p = 0.0382), and total major complications (odds ratio: 0.603, 95% CI: 0.400–0.910, p = 0.0161). Additionally, general anesthesia was associated with a higher amount of intraoperative crystalloid administration and a requirement for more frequent vasopressors. In conclusion, PNB appears to be protective against complications following LEA in diabetes patients with coagulopathy.

scholarly journals Evaluation of major and minor lower extremity amputation in diabetic foot patients

2017 ◽  
Vol 47 ◽  
pp. 1109-1116 ◽  
Author(s):  
Fırat OZAN ◽  
Kaan GÜRBÜZ ◽  
İlhami ÇELİK ◽  
Zehra BEŞTEPE DURSUN ◽  
Erdal UZUN
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Lower Extremity Amputation ◽  
Extremity Amputation

Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death

2017 ◽  
Vol 11 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Dane K. Wukich ◽  
Katherine M. Raspovic ◽  
Natalie C. Suder
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Lower Extremity Amputation ◽  
Controlled Study ◽  
Control Group ◽  
Diabetic Patients ◽  
Charcot Neuroarthropathy ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Extremity Amputation

Background. The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. Methods. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non–diabetes-related foot pathology. Results. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Conclusion. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Levels of Evidence: Level II: Prospective, Case controlled study

Comparing outcomes after peripheral nerve block versus general anesthesia for lower extremity amputation: a nationwide exploratory retrospective cohort study in Japan

2020 ◽  
Vol 45 (6) ◽  
pp. 399-404 ◽  
Author(s):  
Hiroaki Abe ◽  
Masahiko Sumitani ◽  
Hiroki Matsui ◽  
Shotaro Aso ◽  
Reo Inoue ◽  
...  
Keyword(s):  
Propensity Score ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Postoperative Delirium ◽  
Peripheral Nerve Block ◽  
Lower Extremity Amputation ◽  
Significant Difference ◽  
Extremity Amputation

Background and objectivesThe health benefits of peripheral nerve block (PNB) on postoperative complications after lower extremity amputation (LEA) compared with general anesthesia (GA) remains controversial. We performed a retrospective propensity score-matched cohort analysis to compare major outcomes after LEA with PNB versus GA.Materials and methodsWe used a nationwide inpatient database in Japan to compare patient outcomes after LEA with PNB versus GA from 2010 to 2016. Our primary outcome was 30-day mortality after LEA. The incidence of composite morbidity from life-threatening complications and of delirium within 30 days after LEA were secondary outcomes. We conducted propensity score-matched analyses of patients who underwent below knee or foot amputation using 36 covariates. Logistic regression analyses fitted with generalized estimating equations were performed to calculate ORs and their 95% CIs.ResultsOf 11 796 patients, 747 received PNB and 11 049 received GA. After one-to-four propensity score matching, 747 patients were included in the PNB group and 2988 in the GA group. The adjusted ORs for postoperative mortality, composite morbidity and delirium within 30 days after LEA were 1.11 (95% CI 0.75 to 1.64), 1.15 (95% CI 0.85 t o1.56) and 0.75 (95% CI 0.57 to 0.98), respectively, for the PNB group with reference to the GA group.ConclusionsThere was no significant difference between groups in 30-day mortality or composite morbidity. The PNB group showed a significantly lower risk of postoperative delirium than the GA group. Our findings suggest that PNB may have advantages over GA in preventing postoperative delirium among patients undergoing LEA.

scholarly journals Diabetes-related lower extremity amputations in Singapore

2016 ◽  
Vol 26 (2) ◽  
pp. 76-80 ◽  
Author(s):  
Yee Ang ◽  
Chun Wei Yap ◽  
Nakul Saxena ◽  
Lee-Kai Lin ◽  
Bee Hoon Heng
Keyword(s):  
Mortality Rate ◽  
Lower Extremity ◽  
Lower Limb ◽  
Complete Loss ◽  
Lower Extremity Amputation ◽  
Preventive Strategies ◽  
Mortality Trend ◽  
Extremity Amputation ◽  
Anatomical Plane ◽  
Diabetes Patients

Background: Lower extremity amputation (LEA) is defined as the complete loss in the transverse anatomical plane of any part of the lower limb. The objective of this study is to look at the trend and mortality trend of LEA performed in diabetes patients from 2008 to 2013. Methods: All patients age 15 and above with diabetes mellitus who had undergone LEAs (both major and minor) in Tan Tock Seng Hospital, Singapore from 1 January 2008 to 31 December 2013 were included. The outcomes of interest were deaths from all causes within 30 days and within 1 year. Results: Major LEA rate has increased from 11.0 per 100,000 population in 2008 to 13.3 per 100,000 population in 2013. The 30-day mortality rate ranges from 6.0% to 11.1% and the 1-year mortality rate ranges from 24.3% to 30.6%. Minor LEA rate has increased from 10.8 per 100,000 population in 2008 to 13.9 per 100,000 population in 2013. The 30-day mortality rate ranges from 1.5% to 3.7% and the 1-year mortality rate ranges from 9.7% to 18.3%. Conclusions: The trends in major and minor LEA are increasing. The 30-day and 1-year mortality for both major and minor LEA are comparable to figures reported worldwide. There is a need to re-look at preventive strategies to reduce LEA in diabetes patients in Singapore.

scholarly journals Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot Infection

Diabetes Care ◽  
2011 ◽  
Vol 34 (8) ◽  
pp. 1695-1700 ◽  
Author(s):  
Benjamin A. Lipsky ◽  
John A. Weigelt ◽  
Xiaowu Sun ◽  
Richard S. Johannes ◽  
Karen G. Derby ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Risk Score ◽  
Diabetic Foot ◽  
Lower Extremity Amputation ◽  
Diabetic Foot Infection ◽  
Extremity Amputation
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