title: Risk factors for primary major amputation in diabetic patients.
abstract: OBJECTIVE
  Diabetic patients present high risk of having to undergo minor or major amputation during their lifetimes, because of ischemia or infection. The aim of this study was to identify and quantify risk factors for major amputation in diabetic patients with foot infections.
  
  
  METHODS
  Retrospective clinical-surgical trial at the Vascular Surgery Service of Santa Casa de São Paulo.
  
  
  METHODS
  Ninety-nine patients with diabetic foot infections who underwent 129 hospitalizations in the Vascular Surgery Unit were analyzed in accordance with a pre-established protocol to compare two groups of diabetic patients: one that underwent major amputations and the other that underwent minor amputations or debridements. The patients were predominantly male, in their sixth decade of life, and had type 2 diabetes mellitus. Chronic arterial insufficiency, age, diabetes mellitus duration, ascending lymphangitis, calcaneal lesions, Wagner's classification, laboratory tests and different microorganisms in deep tissue cultures were the risk factors evaluated in all patients.
  
  
  RESULTS
  The statistically significant risk factors for major amputation included age, ascending lymphangitis (odds ratio, OR: 2.5), calcaneal lesions (OR: 10.5), Wagner grade 5 lesions (OR: 3.4), chronic arterial insufficiency without possibility of revascularization (OR: 5.4) and diabetes duration. Presence of Gram-positive microorganisms was associated with the need of major amputation. The serum urea, creatinine, glucose and white blood cell levels were not significant risk factors for major amputation.
  
  
  CONCLUSIONS
  The risk factors for major amputation were: age, ascending lymphangitis, calcaneal lesions, Wagner grade 5 lesions, arterial insufficiency, diabetes duration and Gram-positive microorganisms in cultures.
authors.affiliation: Vascular Surgery Unit, Department of Surgery, Faculdade de Ciências Médicas da Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil. vansanbr@hotmail.com
authors.forename: Vanessa Prado
authors.initials: VP
authors.lastname: Dos Santos
authors.forename: Denise Rabelo
authors.initials: DR
authors.lastname: da Silveira
authors.forename: Roberto Augusto
authors.initials: RA
authors.lastname: Caffaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D001424:Bacterial Infections / Q000382:microbiology*; D017719:Diabetic Foot / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014946:Wound Infection / Q000382:microbiology*