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High amputation, mortality rates among patients with diabetic foot syndrome
German patients hospitalized with diabetic foot syndrome had higher amputation and mortality rates vs. patients hospitalized with peripheral artery disease, according to recent study findings.
Nasser M. Malyar, MD, of the division of vascular medicine, department of cardiovascular medicine at University Hospital Muenster, Germany, and colleagues analyzed insurance data from 40,335 patients hospitalized between 2009 and 2011 with a diagnosis of peripheral artery disease (PAD) or diabetic foot syndrome. Researchers divided patients into three groups: those with a main diagnosis of diabetic foot syndrome (17.3%), patients with PAD plus diabetes (21.5%) and those with PAD alone (61.2%). Researchers assessed in-hospital and long-term outcomes related to major and minor amputation and mortality, and they calculated cumulative amputation-free survival and overall survival rates using Kaplan-Meier analysis.
Researchers found that patients with diabetic foot syndrome had the highest amputation rate (31.9%) vs. those with PAD and diabetes (11.1%) or PAD alone (6%); however, patients with diabetic foot syndrome also had the lowest revascularization rate (18.2% vs. 67.8% vs. 71.6%, respectively).
Patients with diabetic foot syndrome also had the lowest cumulative 4-year survival (57.4%) vs. patients with PAD and diabetes (60.8%) or PAD alone (70%), as well as the lowest amputation-free survival (45.4% vs. 74.4% vs. 86.5%, respectively). Length of hospital stay and costs for in-hospital treatment also were highest for patients with diabetic foot syndrome, followed by patients with PAD plus diabetes or PAD alone (P < .001).
Patients hospitalized with diabetic foot syndrome exhibited the highest minor reamputation risk for the contralateral limb and an equal risk for reamputation for the ipsilateral limb when compared with PAD plus diabetes patients.
“The high rates of ipsi- and contralateral reamputation and the poor overall survival rate after 4 years of follow-up indicate that, particularly, [diabetic foot syndrome] patients have to be considered ‘patient at-risk’ rather than ‘limb at-risk’ because of the drastically reduced life expectancy,” the researchers wrote. “Therefore, patients with a diabetic foot ulcer not only need a thorough vascular diagnostic workup for avoiding amputations, they also are in desperate need for intensive overall care focusing on lifestyle modification and a strict control of [CV] risk factors for reduction of the high rate of [CV] events.” – by Regina Schaffer
Disclosure: Malyar reports receiving travel support from Bard, Bayer, Cordis, Daiichi-Sanko and Medtronic, and speaker honoraria from Medac and UCB Pharma. One researcher reports receiving grants for participation in multicenter trials from Bard, Bayer, Biotronik and Pluristem Therapeutics, and consulting fees from Bristol-Myers Squibb and Pluristem Therapeutics.