title: Preoperative blood glucose and prognosis in diabetic patients undergoing lower extremity amputation.
abstract: BACKGROUND
  Previous work has shown that uncontrolled diabetes mellitus is associated with adverse surgical outcomes. The purpose of the present study was to establish if a high peri-operative random blood sugar (RBS) concentration among patients with diabetes with non-traumatic lower-extremity amputation (LEA) is a decisive factor behind post-operative outcomes (re-amputation/mortality) within three months after the first amputation.
  
  
  METHODS
  In this retrospective cohort study, the independent sample t-test, Pearson's chi-squared test and a Cox proportional hazards model were used.
  
  
  RESULTS
  A total of 270 patients underwent non-traumatic LEA of whom 105 had diabetes, whereas 81 patients were included for this study. The mean age was 71 years (standard deviation: ± 11.8). Mortality was 27% and 16% were re-amputated within three months after their first amputation.The median pre-operative RBS level was 8.6 mmol/l (range: 4.6-18.7 mmol/l) with tertile ranges as follows: Q1 4.0-7.0 mmol/l; Q2 7.1-11.0 mmol/l; Q3 > 11.0 mmol/l. For the Q3 tertile, the age-adjusted hazard ratio for re-amputation was 0.77 (95% confidence interval (CI): 0.16-3.62) and for mortality it was 1.90 (95% CI: 0.50-7.22), with the Q1 tertile as the reference group.
  
  
  CONCLUSIONS
  This study does not confirm that a high peri-operative RBS level can predict increased mortality or re-amputation among patients with diabetes who undergo non-traumatic LEA. Furthermore, based on our results, we cannot inform clinical decision-making about whether to delay or to avoid elective surgery in patients with a high RBS preoperatively. Further investigation is warranted.
  
  
  BACKGROUND
  none.
  
  
  BACKGROUND
  This trial was registered with the Danish Data Protection Agency (record no. 01975 HVH-2012-053).
authors.affiliation: dr_raj_nayak@yahoo.com.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Nayak
authors.forename: Klaus
authors.initials: K
authors.lastname: Kirketerp-Møller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000401:mortality / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000401:mortality / Q000601:surgery; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose