Outcomes following Lower Extremity Amputation in Patients with Diabetes Mellitus and Peripheral Arterial Disease

Background: Lower extremity amputations (LEAs) are projected to increase drastically in the United States. The potential effects of diabetes mellitus (DM) and peripheral arterial disease (PAD) on LEA outcomes have not been well-explored. We sought to investigate the clinical outcomes of LEA in patients with DM alone, PAD alone, and patients with concurrent DM and PAD (DM + PAD) from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Methods: Adult patients (>= 18 years) undergoing LEA in 2007-2011 based on ICD-9 procedure codes were selected. Patient morbidity, and mortality were assessed utilizing logistic and linear regression. Multivariable analyses adjusted for additional patient and hospital characteristics. Results: A total of 62,291 LEAs were identified between 2007 and 2011. The mean (SD) age was 66.4 (13.7) years. Patients were predominantly Caucasian (56.4%), male (62.9%), and admitted as an emergency admission (44.1%). A higher incidence of LEA was observed in patients with DM + PAD (47.3%) than those with either DM alone (26.4%) or PAD alone (26.3%). On adjustment for patient characteristics, PAD alone was associated with significantly higher mortality and complications postoperatively (OR 1.71; P < 0.001, and 1.28; P < 0.001, respectively), but concurrent DM + PAD was not associated with these outcomes. Conclusion: Outcomes were significantly affected by presence of PAD as a comorbidity in patients undergoing LEA. It is imperative to understand and enhance preventive measures and screening guidelines for such comorbidities to optimize postoperative outcomes to ensure best-practice care in this patient population.