Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2024; 15(4): 629-637
Published online Apr 15, 2024. doi: 10.4239/wjd.v15.i4.629
Prevalence and risk factors of wound complications after transtibial amputation in patients with diabetic foot
Young Uk Park, Seong Hyuk Eim, Young Wook Seo
Young Uk Park, Seong Hyuk Eim, Young Wook Seo, Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Hospital, Suwon 16499, South Korea
Author contributions: Park YU and Seo YW designed the research study, and performed the research; Park YU, Seo YW and Eim SH analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: Ethical approval for this study was obtained from the Institutional Review Board of Ajou University School of Medicine.
Informed consent statement: The study is retrospective and does not impact human subjects, thereby not requiring consent forms.
Conflict-of-interest statement: The authors received no financial support for the research, authorship, and/or publication of this article.
Data sharing statement: Statistical code, and dataset available from the corresponding author at syw0103@gmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Young Wook Seo, MD, Assistant Professor, Doctor, Surgeon, Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Hospital, No. 164 World Cup Road, Yeongtong-gu, Suwon 16499, South Korea. syw0103@gmail.com
Received: October 30, 2023
Peer-review started: October 30, 2023
First decision: December 12, 2023
Revised: December 28, 2023
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: April 15, 2024
Processing time: 164 Days and 19.5 Hours
ARTICLE HIGHLIGHTS
Research background

Diabetic foot (DMF) complications are common and are increasing in incidence. Risk factors related to wound complications are yet to be established after transtibial amputation under the diagnosis of DMF infection.

Research motivation

The purpose of this study was to analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes.

Research objectives

Having knowledge of the research findings on the prevalence and risk factors of wound complications after transtibial amputation in patients with DMF, we can utilize this information in a clinical setting for purposes such as predicting patient outcomes and providing explanations to patients.

Research methods

Seventy-two patients with DMF infection underwent transtibial amputations between April 2014 and March 2023. The medical records and photographs stored in Picture Archiving and Communication System were analyzed to ascertain the presence of wound complications and to categorize the types of wound complications. The occurrence of postoperative wound complications after transtibial amputation surgery was classified into two groups and the contribution of each risk factor was analyzed. Group 1 was defined as cases without wound complications after transtibial amputation surgery in DMF patients, and Group 2 was defined as cases with wound complications.

Research results

Among the 72 cases, 12 cases (16.7%) were performed with additional wound management (stump revision = 11 cases; transfemoral amputation = 1 case). In 12 cases, wound healing did not progress satisfactorily with a simple dressing alone, necessitating daily debridement to address infection or necrotic tissue. Compared with hemoglobin A1c (HbA1c) level of Group 1 (7.54), the HbA1c level of Group 2 (9.32) was significantly higher (P = 0.01). The optimal HbA1c cutoff for postoperative wound complications was calculated using the receiver operating characteristic curve, and the result was an HbA1c of 7.2. The prevalence of a history of kidney transplantation in Group 2 was significantly greater than that in Group 1 (P = 0.02) In Group 2, the HbA1c level was significantly higher at 8.77 than the HbA1c level of 7.07 in Group 1 (P = 0.01) [odds ratio (OR): 29.65]. The prevalence of a history of kidney transplantation in Group 2 (33.3%) was significantly higher compared to Group 1 (11.7%) (P = 0.03) (OR: 21.24).

Research conclusions

In this study, 43.1% of the patients with transtibial amputation surgery experienced wound complications, and 16.7% necessitated additional wound revision procedures. High HbA1c levels (HbA1c > 7.2) and kidney transplant history are risk factors for postoperative wound complications.

Research perspectives

No research has been conducted yet on the correlation between adjusting risk factors and reducing complications, highlighting the need for future studies in this area.