Associated Factors for Lower Extremity Amputation in Patients Admitted with Diabetic Foot Ulcers: A Retrospective Single Center Audit

Background: Diabetes foot ulcer (DFU) is a serious and much feared complication of diabetes. Ulcerations of diabetes foot which developed gangrene can take weeks or months to heal and can sometimes not heal at all so that amputation for non-traumatic causes is a frequent outcome in the diabetic foot. Notwithstanding this, apparently, there is no systematic research has so far been conducted to assess associated factors for lower extremity amputation in patients admitted with DFU in Yemen. Aims: We aimed to determine associated factors for lower extremity amputation in patients who were admitted with DFU to Al-Thawra Modern General Hospital, Sana’a city, Yemen. Patients and Methods: Between November 2021 and April 2022, a retrospective observational study of patients was conducted at Al-Thawra Modern General Hospital, Sana’a city, Yemen. We included patients 20 years of age and over with a confirmed diagnosis of either type 1 or type 2 diabetes and coexisting DFU. Participants under the age of 20 years, pregnant women, patients who receiving immunosuppressive therapy or radiotherapy, infected at or above the ankle joint, and those with non-diabetic foot ulcers were excluded from analysis. Participants who attended the Hospital for other management purposes (e.g., podiatry reviews, nail pathology, and education about prevention) were also excluded. All related data about the clinical characteristics and health status of patients were collected from medical records. The main outcome factor in our study was amputation.  Results: A total of 53 diabetic patients were enrolled in this study. All participants had type 2 diabetes mellitus. The period prevalence of amputation within the study sample was 54.7%. Almost half (47.2%) of the participants were in the age group 51-60 years with mean age 58.92 ± 11.1 years. Males were predominant (73.6 %). When compared with DFU patients without amputation, patients with amputation had increased rates of hypertension (HTN), history of peripheral artery diseases (PAD), osteomyelitis, Wagner Grade 4, foot necrosis or gangrene as well as increased levels of glycosylated hemoglobin (HbA1c) and first fasting plasma glucose (FPG) post admission. Conclusion: Foot ulcer is one of the major health problems among Yemeni diabetic patients. Our study has shown that independent risk factors for diabetic foot-related amputations in Sana’a city, Yemen included HTN, history of PAD, osteomyelitis, Wagner Grade 4, foot necrosis or gangrene as well as increased levels of HbA1c and FPG. Every effort should be made to avoid it particularly with limited resources for rehabilitation in developing countries.