Risk factors for failure of limb salvage among veterans with foot ulcers |
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| Affiliation: | 1. University of Washington School of Medicine, United States;2. DVA Puget Sound Health Care System, United States;3. Department of Orthopaedics and Sports Medicine, University of Washington, United States;1. University of Montreal, 2900 boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada;2. CHU Ste-Justine, 7905-3175 Côte Ste-Catherine, Montréal, QC, H3T 1C5, Canada;3. Hôpital du Sacré-C?ur de Montréal, 5400 boul. Gouin O, Montreal, QC, H4J 1C5, Canada;4. École Polytechnique, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada;1. Hospital Regional do Gama, Brasilia, Distrito Federal, Brazil;2. Hospital Regional de Planaltina, Brasilia, Distrito Federal, Brazil;3. Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE - H O M E), Brasília, Distrito Federal, Brazil;4. Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil;1. Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan;2. Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan;3. Department of Functional Anatomy, Kanazawa University, Kanazawa, Ishikawa, Japan;1. University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA;2. Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA;3. Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA |
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| Abstract: | BackgroundThere is limited available information to guide early discussions involving limb salvage for patients with non-traumatic foot ulcers. We hypothesized patient, wound and treatment factors identifiable at initial operative treatment would be associated with failure of attempted limb salvage.MethodsWe retrospectively assessed United States military veterans treated operatively for non-traumatic foot ulcers at a Veteran’s Administration (VA) hospital from 2008 to 2018. Cox proportional hazard analysis assessed for independent associations with eventual above ankle amputation.ResultsLimb salvage failed for 52 of 461 patients (11.0%). Univariable associations included initial wound area ≥1 cm (p < .001), immediate TMA (p < .001), diagnosis of PVD (p < .001) or diabetes (p = .005), nonpalpable pulse (p = .006), CKD (p = .023), creatine ≥ 1.5 (p = .004), and HgA1c ≥ 6.2 (p < .001). Independent associations consisted of initial wound area ≥1 cm (HR 6.0, 95% CI 1.4–25.1, p = .014), immediate TMA (HR 3.5, 95% CI 1.9–6.4, p < .001), and PVD (HR 3.5, 95% CI 1.6–7.5, p = .001). When <2 risk factors were present, 99.1% and 96.8% retained their hindfoot at 5 and 10 years, respectively. However, this decreased to 87.3% and 80.1% with two risk factors and fell to 63.3% and 43.3% with three risk factors.ConclusionFailure of limb salvage was increasingly likely as the number of identified independent risk factors increased. These results may assist in prognostication and shared decision making between patients and providers.Level of evidencePrognostic, Level III. |
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| Keywords: | Foot ulcer Limb salvage Amputation Veteran |
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