Acta Orthopaedica et Traumatologica Turcica
Research Articles

Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center


Department of Computer Engineering/Division of Computer Science & Department of Management Information Systems, Söke Faculty of Business, Aydın Adnan Menderes University, Aydın, Turkey


Department of Underwater and Hyperbaric Medicine, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey


Department of Management Engineering, İstanbul Technical University, Faculty of Management, İstanbul, Turkey


Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des connaissances en e-Santé, LIMICS, F-75006 Paris, France


Department of Biology, Division of Botanic, Faculty of Science & Department of Informatics; İstanbul University, İstanbul, Turkey

AOTT 2022; 56: 333-339
DOI: 10.5152/j.aott.2022.22052
Read: 173 Downloads: 92 Published: 01 September 2022

Objective: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs).

Methods: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, oneway analysis of variance (ANOVA) and Spearman correlation analysis.

Results: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of Highdensity lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients.

Conclusion: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients’ amputation risk.

Level of Evidence: Level IV, Prognostic Study

Cite this article as: Demirkol D, Aktaş Ş, Özcan T, Tannier X, Selçukcan Erol Ç. Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center. Acta Orthop Traumatol Turc. 2022;56(5):333-339.

ISSN 1017-995X EISSN 2589-1294