Shin Woo CHOI, Young Ho SHIN, Jae Kwang KIM

Five-year mortality rate for patients with diabetic hand gangrene who undergo upper extremity amputation

Objective: The aim of this study was to describe the characteristics of patientsundergoing upper extremity amputation (UEA) fordiabetic hand gangrene with aspecial focus on mortality and to determine the risk factors for thedevelopment of hand gangrenein diabetic patients.Methods: The medical records of patients who underwent lower extremity amputation (LEA) or UEA because of diabeticgangrene between January 2005 and December 2012 were retrospectively reviewed. Patients were then assigned to one of twogroups: the UEA group (n = 15, 9 male; mean age = 62 ± 12.4) and the LEA group (n = 280, 196 male; mean age = 64.6 ± 10.9). AKaplan-Meier analysis was performed to compare the five-year survival rates between the two groups. A multivariable logisticanalysis including demographic characteristics, laboratory data, and dialysis status was conducted to identify the risk factors fordiabetic hand gangrene.Results: The five-year mortality rate in the UEA group (86.7%, 13 of 15 patients) was significantly higher than that in the LEAgroup (51.8%, 145 of 280 patients, P < 0.001). Dialysis status was determined as a risk factor associated with the development ofdiabetic hand gangrene (OR, 4.05; 95% CI, 1.23-13.29; P = 0.021).Conclusion: Evidence from this study has revealed that that amputation for diabetichand gangrene is associated with a high rateof mortality. Among diabeticpatients, the five-year survival rate of patients who underwent amputation fordiabetic handgangrene was only 13.3%.Level of Evidence: Level IV, Prognostic Study

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