Visual Abstract
Introduction: Nearly 50% of patients with diabetes and foot ulcers have concurrent peripheral artery disease (PAD), which increases risk of amputation events. These patients have a 5-year mortality rate of over 50% after lower extremity amputation. We sought to identify patients with diabetes and PAD in a national patient database to identify predictors of amputation.
Methods: We queried the national Cerner Health Facts EMR database for patients with diabetes and PAD diagnoses between 2010 and 2018. We used Poisson regression to generate risk ratios for variables predictive of lower extremity amputation.
Results: We identified 203,730 patients from 512 sites. The average age of a patient was 68.9 (± 12.02 SD), 57.2% were male, and 77.5% of patients were white; 8.8% (N=17,991) of patients had a documented amputation. History of osteomyelitis (risk ratio [RR] 7.92, 95% confidence interval [CI] 7.66-8.19), history of hypertension (RR 1.54, 95% CI 1.48-1.62), previous limb amputation (RR 1.46, 95% CI 1.41-1.52), were predictive of lower extremity amputation (Figure).
Conclusions: In patients with diabetes and PAD, history of osteomyelitis, history of hypertension, and previous limb amputation were most predictive of a future lower extremity amputation. Patients with the above risk factors should be monitored more closely for clinical indicators that could lead to amputation.
G. Rajagopal: None. J. B. Provance: None. B. Drees: None. M. Abu kishk: None.
