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Predictive Factors for Limb Salvage Versus Amputation in Diabetic Patients with Lower Extremity Wounds
Pooja Humar, BS; Elizabeth A. Moroni, MD MHA; Joseph Mocharnuk, BA; Yadira Villalvazo, MD; Peter Rubin, MD, Brodie Parent, MD, MS
University of Pittsburgh Medical Center
2023-01-31
Presenter: Pooja Humar
Affidavit:
All work on this project represents the original work of the included authors
Director Name: J. Peter Rubin
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Lower extremity (LE) wounds are common sequela of diabetes and vascular disease, and may progress to amputation. This study aims to determine predictive factors for delayed wound healing, limb loss, and limb salvage.
Methods: A retrospective review of patients seen at an outpatient wound care clinic network from 2015-2022 was completed. Patients with diagnosed diabetes and a non-traumatic LE wound were included. Multinomial logistic regression was performed on a combination of numerical and categorical variables. Backwards selection was used, optimizing for the Akaike Information Criterion (AIC) estimator of prediction error, and likelihood ratio was used to assess for statistical significance.
Results: 3,632 patients had non-traumatic LE ulcers with an average of 3 wounds per patient. Of these patients, 542 (14.9%) underwent amputation. Area deprivation index (ADI) (p <0.0001), number of wound clinic encounters (p<0.01), and active smoking (p=0.046) were all associated with limb salvage. A one point increase in ADI and active smoking were associated with a 5% and 47% decrease in probability of wound healing, respectively, whereas an increase of one wound care clinic visit was associated with a 12% increased probability of wound healing. The predictive model for amputation included the same covariates.
Conclusions: In patients with diabetic LE wounds, high ADI and active smoking are associated with wound progression while wound clinic encounters are protective. Limb loss is a critical population health issue. Based on these data, future limb salvage efforts should focus on increasing patient access to wound centers, optimizing social support, and complete cessation of smoking.
