Evaluation of Factors Causing a Delay in Management and Hospital Stay in Diabetic Foot Amputation Patients: A Prospective Cohort Study

Authors

  • Syeda Anjala Tahir Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.
  • Shaheen Bhatti Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.
  • Zille Huma Department of General Medicine, Dow University Hospital, Karachi, Pakistan.
  • Muhammad Ahsan Khan Department of Internal medicine, Dow University of Health Sciences, Civil Hospital, Karachi
  • Areeba Rehman Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.
  • Shumaila Tahir District Health office, District east karachi, department of health, government of sindh
  • Amanullah Abbasi Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.

Keywords:

Lower limb amputation, Diabetic foot, , Preoperative hurdles, diabetic ulcer, Diabetes mellitus

Abstract

OBJECTIVE: To determine the rate of different amputation levels in diabetic foot patients and the
incidence of repetitive foot surgeries and evaluate the factors causing a delay in hospital stay and
amputation of patients.
METHODOLOGY: This prospective cohort study was conducted in Dr. Ruth K.M. Pfau, Civil Hospital
Karachi, Pakistan. The study selected 375 participants from the clinic's daily patient inflow from October 2021 to March 2022 using a non-probability consecutive sampling technique. Those who had a delay in hospital stay and amputation were further followed up from May - October 2022. The chi-square test and Kruskal Wallis test (p-value <0.05) were used to correlate the effect of the level of lower limb amputation and the cause of delay in amputation using SPSS version 24.0.
RESULTS: Total 246(65.60%) were males and 129(34.40%) were females. Toe amputation was the most commonly seen amputation in 173(46.1%) participants. About 168(44.8%) patients had some in-hospital delay stay during their treatment. Preoperative hurdles (Uncontrolled RBS, Osteomyelitis, etc.) were the most common factor causing an in-hospital delay in 92(24.5%) patients. The level of amputation performed was found to be statistically significant with factors causing a delay in hospital stay through chi-square (p=0.003*) and Kruskal Wallis test H (2) statistic= 13.3, df = 3, H (2), P=0.004*).
CONCLUSION: Diabetic foot is a frequent cause of amputation globally, majorly in developing countries like Pakistan. On-time provision of treatment to these patients can decline the global amputation rate due to diabetic foot ulcers.

Author Biographies

Syeda Anjala Tahir, Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.

Consultant Physician

Shaheen Bhatti, Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.

Professor of medicine

Zille Huma, Department of General Medicine, Dow University Hospital, Karachi, Pakistan.

Assistant Professor

Muhammad Ahsan Khan, Department of Internal medicine, Dow University of Health Sciences, Civil Hospital, Karachi

Medical Houseofficer

Areeba Rehman, Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.

Medical Houseofficer

Shumaila Tahir, District Health office, District east karachi, department of health, government of sindh

Woman medical officer

Amanullah Abbasi, Department of internal medicine, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.

Head of department

References

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019; 157: 107843. doi:10.1016/j.diabres.2019.107843. Epub 2019 Sep 10.

NG BW, Firdaus AM, Syafiqq Al Hakim HRM, Nur Saidah MS, Loi KW, Ong KC et al. Diabetic foot infection and surgical treatment in a secondary health care centre in Malaysia. Med J Malaysia. 2020; 75(1): 29-32.

Khan A, Junaid N. Prevalence of diabetic foot syndrome amongst population with type 2 diabetes in Pakistan in primary care settings. J Pak Med Assoc. 2017; 67(12): 1818-1824.

Syed F, Arif MA, Afzal M, Niazi R, Ramzan A, Hashmi UE. Footcare behaviour amongst diabetic patients attending a federal care hospital in Pakistan. J Pak Med Assoc. 2019; 69(1): 58-63.

Naqvi IH, Talib A, Naqvi SH, Yasin L, Rizvi NZ. The Neuro-Vascular Consequence of Diabetes: Foot Amputation and Evaluation of its Risk Factors and Health-Related Economic Impact. Curr Vasc Pharmacol. 2021; 19(1): 102-109. doi:10.2174/1570161118666200320112401.

Ammar AS, Khalid R, Malik U, Zeb M, Abbas HM, Khattak SB. Predictors of lower limb amputations in patients with diabetic foot ulcers presented in a tertiary care hospital of Pakistan. J Pak Med Assoc. 2021; 71(9): 2163-2166.

doi: 10.47391/JPMA.06-932.

Raosoft Online Sample Size Calculator[Online] 2004[Cited 2018; 2018 July 4] Available from: http:www.raosoft.comsamplesize.html [accessed July 2021]

Game F. Classification of diabetic foot ulcers. Diabetes / Metabolism Research and Reviews. 2016; 32: 186-194. doi: 10.1002/DMRR.2746.

Sarang B, Bhandoria G, Patil P. Assessing the Rates and Reasons of Elective Surgical Cancellations on the Day of Surgery: A Multicentre Study from Urban Indian Hospitals. World J Surg. 2022; 46(2): 382-390. doi: 10.1007/s00268-021-06364-1.

Nather A, Wong KL. Distal amputations for the diabetic foot. Diabet Foot Ankle. 2013; 4: 10.3402/dfa.v4i0.21288. doi:10.3402/dfa.v4i0. 21288.

Bekele F, Chelkeba L. Amputation rate of diabetic foot ulcer and associated factors in diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: prospective observational study. J Foot Ankle Res. 2020; 13(1): 65. doi:10.1186/s13047-020-00433-9.

Salahuddin O, Azhar M, Imtiaz A, Latif M. A developing world experience with distal foot amputations for diabetic limb salvage. Diabet Foot Ankle. 2013; 4: 10.3402/dfa.v4i0.22477. doi:10.3402/dfa.v4i0. 22477.

Jain AKC, Tejasvitaa RS. To Determine the Pattern and Type of Amputation Done In Diabetic Foot Patients in a Teaching Hospital. EAS J Med Surg. 2019; 1(3): 94-99.

Spoden M, Nimptsch U, Mansky T. Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015 [published correction appears in BMC Health Serv Res. 2019 Mar 14; 19(1): 163]. BMC Health Serv Res. 2019; 19(1): 8. Published 2019 Jan 6. doi: 10.1186/s12913-018-3759-5.

Pemayun TG, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle. 2015; 6: 29629.

doi: 10.3402/dfa.v6.29629.

Labeeq M, Tariq MA, Tung SA, Yar MA, Rehman W, Ehsan SB. The Economic Impact of Lower Extremity Amputations in Diabetics. A retrospective study from A Tertiary Care Hospital of Faisalabad, Pakistan. Pak J Surg Med. 2020; 1(1): 18-22. doi: 10.5281/zenodo.3595027.

Kerr M, Barron E, Chadwick P. The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabet Med. 2019; 36(8): 995-1002. doi: 10.1111/DME.13973.

Monge L, Gnavi R, Carnà P, Broglio F, Boffano GM, Giorda CB. Incidence of hospitalization and mortality in patients with diabetic foot regardless of amputation: a population study. Acta Diabetol. 2020; 57(2): 221-228.

doi: 10.1007/S00592-019-01412-8.

Liu R, Petersen BJ, Rothenberg GM, Armstrong DG. Lower extremity reamputation in people with diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2021; 9(1): e002325.

doi: 10.1136/BMJDRC-2021-002325.

Murdoch DP, Armstrong DG, Dacus JB, Laughlin TJ, Morgan CB, Lavery LA. The natural history of great toe amputations. J Foot Ankle Surg. 1997; 36(3): 204-208. doi: 10.1016/S1067-2516(97)80116-0.

Malay DS, Margolis DJ, Hoffstad OJ, Bellamy S. The incidence and risks of failure to heal after lower extremity amputation for the treatment of diabetic neuropathic foot ulcer. J Foot Ankle Surg. 2006; 45(6): 366-374.

doi: 10.1053/J.JFAS.2006.08.002.

Lázaro Martínez JL, Álvarez YG, Tardáguila-García A, Morales EG. Optimal management of diabetic foot osteomyelitis: challenges and solutions. Diabetes Metab Syndr Obes. 2019; 12: 947-959. doi: 10.2147/DMSO.S181198.

Aragón-Sánchez J. Treatment of diabetic foot osteomyelitis: A surgical critique. International Journal of Lower Extremity Wounds. 2010; 9(1): 37-59. doi:10.1177/1534734610361949.

Riaz M, Miyan Z, Waris N. Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan. Int Wound J. 2019; 16(3): 768-772. doi:10.1111/IWJ.13095.

Jokhio AL, Soomro SH, Khuhawer SR, Kandhro MA, Chandio MA. Reasons for cancellation of elective surgical procedures at Chandka Medical College Hospital, Larkana, Pakistan. RMJ. 2014; 39(1): 61-64.

Ayyaz M, Butt UI, Umar M, Khan WH, Kashif MR, Hyidar Z. Effect of COVID-19 on the Working of a Tertiary Care Hospital. J Coll Physicians Surg Pak. 2020; 30(10): S164-S167. doi: 10.29271/JCPSP.2020.SUPP2.S164.

Downloads

Published

2023-03-29

How to Cite

1.
Tahir SA, Bhatti S, Huma Z, Khan MA, Rehman A, Tahir S, Abbasi A. Evaluation of Factors Causing a Delay in Management and Hospital Stay in Diabetic Foot Amputation Patients: A Prospective Cohort Study. J Liaq Uni Med Health Sci [Internet]. 2023 Mar. 29 [cited 2023 May 30];22(01):14-21. Available from: http://ojs.lumhs.edu.pk/index.php/jlumhs/article/view/1051