title: Preanesthetic mortality prediction in diabetics undergoing major lower limb amputation at a tertiary referral hospital: Implications of preoperative echocardiographic and laboratory values.
abstract: OBJECTIVE
  Cardiac comorbidities in patients undergoing amputation due to diabetic foot ulcer are associated with high mortality rates. The authors investigated whether preanesthetic echocardiographic and laboratory values can predict inhospital mortality in type II diabetes patients undergoing major lower limb amputation under spinal anesthesia.
  
  
  METHODS
  The archived medical records of 215 patients were retrospectively reviewed. Demographic data and preoperative laboratory and transthoracic echocardiographic values were analyzed by multivariate logistic regression for factors independently associated with inhospital mortality.
  
  
  RESULTS
  Of the 215 patients, 12 died in hospital after amputation. Preoperative hemoglobin level (hazard ratio, 0.082; 95% confidence interval, 0.013-0.509; P = .007) and left ventricular ejection fraction (hazard ratio, 0.874; 95% confidence interval, 0.779- 0.981; P = .023) were found to be significant predictors of inhospital mortality.
  
  
  CONCLUSIONS
  Preoperative hemoglobin level and left ventricular ejection fraction are highly correlated with inhospital mortality in type II diabetes patients undergoing major lower extremity amputation under spinal anesthesia.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Jung Ju
authors.initials: JJ
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Kyung Cheon
authors.initials: KC
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea. Electronic address: endless37@gilhospital.com.
authors.forename: Youn Yi
authors.initials: YY
authors.lastname: Jo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality; D015897:Comorbidity; D017719:Diabetic Foot / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Amputation; Mortality; Type II diabetes