Transmetatarsal amputations in patients with diabetes mellitus: A contemporary analysis from an academic tertiary referral centre in a developing community
Transmetatarsal amputation (TMA) involves the surgical removal of the distal portion of metatarsals in the foot. It aims to maintain weight-bearing and independent ambulation while eliminating the risk of spreading soft tissue infection or gangrene. This study aimed to explore the risk factors and s...
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| description | Transmetatarsal amputation (TMA) involves the surgical removal of the distal portion of metatarsals in the foot. It aims to maintain weight-bearing and independent ambulation while eliminating the risk of spreading soft tissue infection or gangrene. This study aimed to explore the risk factors and surgical outcomes of TMA in patients with diabetes at an academic tertiary referral center in Jordan. Medical records of all patients with diabetes mellitus who underwent TMA at King Abdullah University Hospital, Jordan, between January 2017 and January 2019 were retrieved. Patient characteristics along with clinical and laboratory findings were analyzed retrospectively. Pearson's chi-square test of association, Student's t-test, and multivariate regression analysis were used to identify and assess the relationships between patient findings and TMA outcome. The study cohort comprised 81 patients with diabetes who underwent TMA. Of these, 41 (50.6%) patients achieved complete healing. Most of the patients were insulin-dependent (85.2%). Approximately half of the patients (45.7%) had severe ankle-brachial index (ABI). Thirty patients (37.1%) had previous revascularization attempts. The presence of peripheral arterial disease (P |
| doi_str_mv | 10.1371/journal.pone.0277117 |
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It aims to maintain weight-bearing and independent ambulation while eliminating the risk of spreading soft tissue infection or gangrene. This study aimed to explore the risk factors and surgical outcomes of TMA in patients with diabetes at an academic tertiary referral center in Jordan. Medical records of all patients with diabetes mellitus who underwent TMA at King Abdullah University Hospital, Jordan, between January 2017 and January 2019 were retrieved. Patient characteristics along with clinical and laboratory findings were analyzed retrospectively. Pearson's chi-square test of association, Student's t-test, and multivariate regression analysis were used to identify and assess the relationships between patient findings and TMA outcome. The study cohort comprised 81 patients with diabetes who underwent TMA. Of these, 41 (50.6%) patients achieved complete healing. Most of the patients were insulin-dependent (85.2%). Approximately half of the patients (45.7%) had severe ankle-brachial index (ABI). Thirty patients (37.1%) had previous revascularization attempts. The presence of peripheral arterial disease (P<0.05) exclusively predicted poor outcomes among the associated comorbidities. Indications for TMA included infection, ischemia, or both. The presence of severe ABI ([less than or equal to]0.4, P<0.01) and a previous revascularization attempt (P<0.05) were associated with unfavorable outcomes of TMA. Multivariate analysis that included all demographic, clinical, and laboratory variables in the model revealed that insulin-dependent diabetes, low albumin level ( 150 mg/L), and low score of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC, <6) were the main factors associated with poor TMA outcomes. TMA is an effective technique for the management of diabetic foot infection or ischemic necrosis. However, attention should be paid to certain important factors such as insulin dependence, serum albumin level, and LRINEC score, which may influence the patient's outcome.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0277117</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Albumin ; Amputation ; Amputations of foot ; Ankle ; C-reactive protein ; Care and treatment ; Chi-square test ; Colleges & universities ; Comorbidity ; Complications and side effects ; Demographic variables ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (insulin dependent) ; Diabetic foot ; Fasciitis ; Foot diseases ; Gangrene ; Health risks ; Hemoglobin ; Hospitals ; Infections ; Insulin ; Ischemia ; Laboratories ; Medical records ; Multivariate analysis ; Necrosis ; Necrotizing fasciitis ; Patient outcomes ; Patients ; Regression analysis ; Risk analysis ; Risk factors ; Sepsis ; Serum albumin ; Soft tissues ; Statistics ; Surgical techniques ; Tertiary</subject><ispartof>PloS one, 2022-11, Vol.17 (11), p.e0277117-e0277117</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Aljarrah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Aljarrah et al 2022 Aljarrah et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c599t-924c2835e99065a1e0b4eef116e2b6e3f7d63d3ac35529bd704a378bb92057dc3</citedby><cites>FETCH-LOGICAL-c599t-924c2835e99065a1e0b4eef116e2b6e3f7d63d3ac35529bd704a378bb92057dc3</cites><orcidid>0000-0001-5564-5736 ; 0000-0003-0234-423X ; 0000-0003-0105-6260 ; 0000-0003-2626-5210</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632785/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632785/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids></links><search><contributor>Tan, Tze-Woei</contributor><creatorcontrib>Aljarrah, Qusai</creatorcontrib><creatorcontrib>Allouh, Mohammed Z</creatorcontrib><creatorcontrib>Husein, Anas</creatorcontrib><creatorcontrib>Al-Jarrah, Hussam</creatorcontrib><creatorcontrib>Hallak, Amer</creatorcontrib><creatorcontrib>Bakkar, Sohail</creatorcontrib><creatorcontrib>Domaidat, Hamzeh</creatorcontrib><creatorcontrib>Malkawi, Rahmeh</creatorcontrib><title>Transmetatarsal amputations in patients with diabetes mellitus: A contemporary analysis from an academic tertiary referral centre in a developing community</title><title>PloS one</title><description>Transmetatarsal amputation (TMA) involves the surgical removal of the distal portion of metatarsals in the foot. It aims to maintain weight-bearing and independent ambulation while eliminating the risk of spreading soft tissue infection or gangrene. This study aimed to explore the risk factors and surgical outcomes of TMA in patients with diabetes at an academic tertiary referral center in Jordan. Medical records of all patients with diabetes mellitus who underwent TMA at King Abdullah University Hospital, Jordan, between January 2017 and January 2019 were retrieved. Patient characteristics along with clinical and laboratory findings were analyzed retrospectively. Pearson's chi-square test of association, Student's t-test, and multivariate regression analysis were used to identify and assess the relationships between patient findings and TMA outcome. The study cohort comprised 81 patients with diabetes who underwent TMA. Of these, 41 (50.6%) patients achieved complete healing. Most of the patients were insulin-dependent (85.2%). Approximately half of the patients (45.7%) had severe ankle-brachial index (ABI). Thirty patients (37.1%) had previous revascularization attempts. The presence of peripheral arterial disease (P<0.05) exclusively predicted poor outcomes among the associated comorbidities. Indications for TMA included infection, ischemia, or both. The presence of severe ABI ([less than or equal to]0.4, P<0.01) and a previous revascularization attempt (P<0.05) were associated with unfavorable outcomes of TMA. Multivariate analysis that included all demographic, clinical, and laboratory variables in the model revealed that insulin-dependent diabetes, low albumin level ( 150 mg/L), and low score of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC, <6) were the main factors associated with poor TMA outcomes. TMA is an effective technique for the management of diabetic foot infection or ischemic necrosis. However, attention should be paid to certain important factors such as insulin dependence, serum albumin level, and LRINEC score, which may influence the patient's outcome.</description><subject>Albumin</subject><subject>Amputation</subject><subject>Amputations of foot</subject><subject>Ankle</subject><subject>C-reactive protein</subject><subject>Care and treatment</subject><subject>Chi-square test</subject><subject>Colleges & universities</subject><subject>Comorbidity</subject><subject>Complications and side effects</subject><subject>Demographic variables</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Diabetic foot</subject><subject>Fasciitis</subject><subject>Foot diseases</subject><subject>Gangrene</subject><subject>Health risks</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Infections</subject><subject>Insulin</subject><subject>Ischemia</subject><subject>Laboratories</subject><subject>Medical records</subject><subject>Multivariate analysis</subject><subject>Necrosis</subject><subject>Necrotizing fasciitis</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Sepsis</subject><subject>Serum albumin</subject><subject>Soft tissues</subject><subject>Statistics</subject><subject>Surgical 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amputations in patients with diabetes mellitus: A contemporary analysis from an academic tertiary referral centre in a developing community</title><author>Aljarrah, Qusai ; Allouh, Mohammed Z ; Husein, Anas ; Al-Jarrah, Hussam ; Hallak, Amer ; Bakkar, Sohail ; Domaidat, Hamzeh ; Malkawi, Rahmeh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c599t-924c2835e99065a1e0b4eef116e2b6e3f7d63d3ac35529bd704a378bb92057dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Albumin</topic><topic>Amputation</topic><topic>Amputations of foot</topic><topic>Ankle</topic><topic>C-reactive protein</topic><topic>Care and treatment</topic><topic>Chi-square test</topic><topic>Colleges & universities</topic><topic>Comorbidity</topic><topic>Complications and side effects</topic><topic>Demographic variables</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus 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Hamzeh</au><au>Malkawi, Rahmeh</au><au>Tan, Tze-Woei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transmetatarsal amputations in patients with diabetes mellitus: A contemporary analysis from an academic tertiary referral centre in a developing community</atitle><jtitle>PloS one</jtitle><date>2022-11-03</date><risdate>2022</risdate><volume>17</volume><issue>11</issue><spage>e0277117</spage><epage>e0277117</epage><pages>e0277117-e0277117</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Transmetatarsal amputation (TMA) involves the surgical removal of the distal portion of metatarsals in the foot. It aims to maintain weight-bearing and independent ambulation while eliminating the risk of spreading soft tissue infection or gangrene. This study aimed to explore the risk factors and surgical outcomes of TMA in patients with diabetes at an academic tertiary referral center in Jordan. Medical records of all patients with diabetes mellitus who underwent TMA at King Abdullah University Hospital, Jordan, between January 2017 and January 2019 were retrieved. Patient characteristics along with clinical and laboratory findings were analyzed retrospectively. Pearson's chi-square test of association, Student's t-test, and multivariate regression analysis were used to identify and assess the relationships between patient findings and TMA outcome. The study cohort comprised 81 patients with diabetes who underwent TMA. Of these, 41 (50.6%) patients achieved complete healing. Most of the patients were insulin-dependent (85.2%). Approximately half of the patients (45.7%) had severe ankle-brachial index (ABI). Thirty patients (37.1%) had previous revascularization attempts. The presence of peripheral arterial disease (P<0.05) exclusively predicted poor outcomes among the associated comorbidities. Indications for TMA included infection, ischemia, or both. The presence of severe ABI ([less than or equal to]0.4, P<0.01) and a previous revascularization attempt (P<0.05) were associated with unfavorable outcomes of TMA. Multivariate analysis that included all demographic, clinical, and laboratory variables in the model revealed that insulin-dependent diabetes, low albumin level ( 150 mg/L), and low score of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC, <6) were the main factors associated with poor TMA outcomes. TMA is an effective technique for the management of diabetic foot infection or ischemic necrosis. However, attention should be paid to certain important factors such as insulin dependence, serum albumin level, and LRINEC score, which may influence the patient's outcome.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><doi>10.1371/journal.pone.0277117</doi><tpages>e0277117</tpages><orcidid>https://orcid.org/0000-0001-5564-5736</orcidid><orcidid>https://orcid.org/0000-0003-0234-423X</orcidid><orcidid>https://orcid.org/0000-0003-0105-6260</orcidid><orcidid>https://orcid.org/0000-0003-2626-5210</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2022-11, Vol.17 (11), p.e0277117-e0277117 |
| issn | 1932-6203 1932-6203 |
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| source | Public Library of Science (PLoS) Journals Open Access; PubMed Central(OpenAccess); DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Free Full-Text Journals in Chemistry |
| subjects | Albumin Amputation Amputations of foot Ankle C-reactive protein Care and treatment Chi-square test Colleges & universities Comorbidity Complications and side effects Demographic variables Diabetes Diabetes mellitus Diabetes mellitus (insulin dependent) Diabetic foot Fasciitis Foot diseases Gangrene Health risks Hemoglobin Hospitals Infections Insulin Ischemia Laboratories Medical records Multivariate analysis Necrosis Necrotizing fasciitis Patient outcomes Patients Regression analysis Risk analysis Risk factors Sepsis Serum albumin Soft tissues Statistics Surgical techniques Tertiary |
| title | Transmetatarsal amputations in patients with diabetes mellitus: A contemporary analysis from an academic tertiary referral centre in a developing community |
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