The diabetic foot: An analysis of predictive factors for amputation

ABSTRACT

A retrospective study was undertaken on 103 diabetic patients with foot ulcers who were confined at the UERM Memorial Medical Center from January 1988 to June 1991 with the aim of determining clinical and laboratory criteria which are useful in predicting the need for amputation. Patients were divided into two groups according to treatment modality Group A, debridement (58 patients) and Group B, amputation (45 patients). Nineteen variables chosen from the patients demographic characteristics, clinical histories and evaluation, and laboratory work-up were reviewed, evaluated, and processed using the normal approximation statistics and logistic regression to obtain a resulting set of predictors. Osteomyelitis, leukocytosis, decreased or absent peripheral pulses, systolic hypertension and smoking history were the five variables found to be significantly associated with the need for an ablative surgical procedure. These quantitated variables are entered into the computed logistic equation to obtain a score which will enable us to determine the appropriate therapeutic intervention tailored to the individuals risk status. If the computed value is greater than or equal to 7, amputation should be the course of action. If the computed value is less than or equal to 3, conservative treatment is advocated. If the value obtained is between 3 and 7, the patient is considered a borderline case and proper management will have to depend on the judgment of the surgeon. With this scoring system as a guide, a definitive operation can be performed at an early stage to prevent the burden of multiple operations and the accompanying high morbidity and post-operative mortality rates.