Major Lower Limb Amputations: Recognizing Pitfalls

Risk factors and predictors of prolonged hospital stay in the clinical course of major amputations of the upper and lower extremity a retrospective analysis of a level 1-trauma center

PURPOSE

The objective was to analyze the treatment and complications of the patients after a major amputation of the upper and lower extremities. Risk factors and predictors of a prolonged hospital stay should be outlined.

METHODS

This is a retrospective study of a national Level-1 Trauma center in Germany. In a 10-year period, patients were identified by major amputations in the upper and lower extremities. The medical reports were considered and the results were split into four main groups with analysis on basic-, clinical data, the course on intensive care unit and the outcome. A recovery index was established. The patients' degree of recovery was summed up. Statistical analysis was performed.

RESULTS

81 patients were included. A total of 39 (48.1%) major amputations were carried out on the lower leg and 34 (42.0%) involved the thigh. There were two instances (2.5%) of hip joint disarticulation. 6 major amputations were done on the upper extremities (n = 3 on the upper arm, n = 3 on the forearm). 13.83 ± 17.10 days elapsed between hospital admission and major amputation. The average length of hospital stay was 38.49 ± 26,75 days with 5.06 ± 11.27 days on intensive care unit. Most of the patients were discharged home followed by rehabilitation. A significant correlation was found between the hospital length of stay and the increasing number of operations performed (p = 0.001). The correlation between the hospital length of stay and the CRP level after amputation was significant (p = 0.003).

CONCLUSIONS

Major amputations in trauma patients lead to a prolonged stay in hospital due to severe diseases and complications. Especially infections and surgical revisions cause such lengthenings.

Racial and Ethnic Disparities in the Management of Diabetic Feet

PURPOSE OF REVIEW

Diabetes mellitus is a chronic medical condition affecting many individuals worldwide and leads to billions of dollars spent within the healthcare system for its treatment and complications. Complications from diabetes include diabetic foot conditions that can have a devasting impact on quality of life. Diabetic foot ulcers and amputations occur in minority individuals at an increased rate compared to Caucasian individuals. This review provides an update examining the racial and ethnic disparities in the management of diabetic foot conditions and the differences in rates of amputation.

RECENT FINDINGS

Current research continues to show a disparity as it relates to diabetic foot management. There are novel treatment options for diabetic foot ulcers that are currently being explored. However, there continues to be a lack in racial diversity in new treatment studies conducted in the USA. Individuals from racial and ethnic minority groups have diabetes at higher rates compared to Caucasian individuals, and are also more likely to develop diabetic foot ulcers and receive amputations. Over the last few years, more efforts have been made to improve health disparities. However, there needs to be an improvement in increasing racial diversity when investigating new therapies for diabetic foot ulcers.

Diabetes-Related Lower Extremity Amputations in Romania: Patterns and Changes between 2015 and 2019

Lower extremity amputations (LEAs) are a feared complication of diabetes mellitus (DM). Here we evaluated the recent trends in DM-related LEAs in Romania. We collected data from a national database regarding minor and major LEAs performed between 2015 and 2019 in patients with DM admitted to a public hospital. Absolute numbers of LEAs were presented by year, diabetes type, sex and age; incidence rates of LEAs in the general population were also calculated. Over the study period, 40,499 LEAs were recorded nationwide (83.16% in persons with type 2 DM [T2DM]); on average, the number of LEAs increased by 5.7%/year. This trend was driven by an increased number of LEAs in patients with T2DM; in patients with type 1 DM (T1DM), LEAs decreased over the study period. In patients with T2DM, the increase in minor LEAs was more pronounced than that in major LEAs. The overall number of LEAs showed an increasing trend with age (r = 0.72), which was most pronounced in patients aged ≥70 years. Men had a higher frequency of LEAs than women, regardless of DM type. These data support renewed efforts to prevent and decrease the burden of amputations among patients with DM.

CLINICAL AND EPIDEMIOLOGICAL PROFILE OF PATIENTS SUBMITTED TO LOWER LIMB AMPUTATION

Objective: To characterize the clinical and epidemiological profile of patients undergoing lower limb amputation in a public hospital in southern Piauí state, Brazil. Method: Retrospective and descriptive study, with document analysis and quantitative approach. Data collection took place in July and August 2021, using an instrument developed by the researchers. Data were processed using the statistical software Statistical Package for Social Sciences, version 20.0. Results: The sample consisted of 70 patients with a mean age of 65.59 years, most of them male (61.4%), brown (88.6%), married (48.3%), retired (42.9%), coming from other cities of Piauí (87.1%). Most patients (47.1%) had a comorbidity at the time of amputation, with diabetes mellitus (34.3%) being the most prevalent, followed by systemic arterial hypertension (12.9%). Diabetes was the main cause of amputation (48.6%), being the transfemoral level (42.9%) the most affected. All procedures were performed on an emergency basis, and most hospitalizations (94.3%) progressed to discharge. Conclusion: The findings of this study reveal that people with diabetes, males, and the elderly were the individuals who most underwent amputation, with the transfemoral level being the most performed.

PERFIL CLÍNICO E EPIDEMIOLÓGICO DE PACIENTES SUBMETIDOS A AMPUTAÇÃO DE MEMBROS INFERIORES

Objetivo:Caracterizar o perfil clínico e epidemiológico dos pacientes submetidos à amputação de membros inferiores em um hospital público do sul do Piauí. Métodos: Estudo retrospectivo, descritivo, com análise documental e abordagem quantitativa. A coleta de dados ocorreu nos meses de julho e agosto de 2021, sendo realizada por meio de um instrumento elaborado pelos pesquisadores. Os dados foram processados pelo o software estatístico Statistical Package for Social Sciences, versão 20.0. Resultados: A amostra foi composta por 70 pacientes com média de idade de 65,6 anos, a maioria do sexo masculino (61,4%), de cor parda (88,6%), casada (48,3%), aposentada (42,9%), advinda de outras cidades do Piauí (87,1%). A maioria dos pacientes (47,1%) apresentava uma comorbidade no momento da amputação, sendo o diabetes mellitus (34,3%) a mais prevalente, seguido de hipertensão arterial sistêmica (12,9%). O diabetes mellitus foi a principal causa de amputação (48,6%), sendo a nível transfemoral (42,9%) a mais predominante. Todos os procedimentos foram realizados em caráter de urgência, e grande parte das internações (94,3%) evoluiu para alta. Conclusão: Os achados demonstram que pessoas com diabetes mellitus, do sexo masculino e idosas foram as que mais se submeteram a amputação, sendo o nível transfemoral o mais realizado