Hassan Al-Thani, Moamena El-Matbouly, Maryam Al-Sulaiti, Noor Al-Thani, Mohammed Asim and Ayman El-Menyar Pages 354 - 364 ( 11 )
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.
Lower extremities amputation, diabetes mellitus, HbA1c, mortality, ADA, hemoglobin.
Department of Surgery, Vascular and Trauma Surgery, Hamad General Hospital, Doha, Department of Surgery, Hamad General Hospital, Doha, Department of Surgery, Hamad General Hospital, Doha, Department of Internal Medicine, Hamad General Hospital, Doha, Vascular and Trauma Surgery, Clinical Research, Hamad General Hospital, Vascular and Trauma Surgery, Clinical Research, Hamad General Hospital