Variation in clinical presentation of hospitalized patients with diabetic foot ulcers who underwent lower leg amputation in the Bronx from 2016-2021.

Abstract

Summary: Lower extremity amputation secondary to diabetic foot ulcers (DFU) is associated with a 50% mortality rate within 5 years. The aim of this case series is to understand the risk factors and management of DFU leading to above-knee or below-knee amputation at an urban medical center. We conducted a retrospective review of the medical history, foot examination findings, noninvasive vascular studies, angiographic imaging, and radiology results from hospital stays during which patients underwent amputation. A total of 35 patients with DFU who underwent amputation between 2016 and 2021 were evaluated. Of these, 16 ambulatory patients had complete medical data and were included in the analysis. Risk factors for amputation, clinical presentation, diagnostic findings (e.g. vascular studies or imaging), and amputation approaches were analyzed. Our study found significant variability in the medical history, presentation, and management of patients with DFU who underwent lower extremity amputations, including differences in vascular abnormalities and the timing of care. Poor glucose control (median HbA1c of 10.3%) and delayed presentation likely contributed to tissue loss and amputation. Understanding the individual medical presentations and management of patients undergoing leg amputation secondary to DFU may inform the development of more effective strategies to prevent this complication in patients with diabetes.

Learning points: There is significant variability in the presentation and progression of diabetic foot ulcers (DFUs). Diagnostic evaluation of DFU varies between patients; a more standardized evaluation to inform best practices could be useful. Socioeconomic status (SES) plays a role in the increased risk of amputations among DFU patients, including delay in care and access to limb salvage programs. Multidisciplinary care, including early detection of DFU, patient education, and routine screenings, is essential for improving outcomes and reducing the risk of amputations in high-risk DFU patients.