Factors influencing lower extremity amputation outcomes in people with active foot ulceration in regional Australia

Objectives: This study aimed to determine what factors contribute to the likelihood of lower extremity amputation (LEA) in people with active foot ulceration in regional Australia. This retrospective study audited patients with active foot ulceration in a multidisciplinary high risk foot service (HRFS) in regional Australia. Methods: Neurological, vascular, and wound characteristics were systematically extracted, along with demographic information. Participants were followed for at least 12 months until healing or LEA occurred. Correlations between LEA and clinical and demographic characteristics were assessed using the Pearson’s product moment correlation coefficient and chi squared test for independence. Direct logistic regression assessed the independent contribution of significantly correlated variables on the likelihood of LEA. Results: Of note, 1876 records were hand screened with 476 participants (25%) meeting the inclusion criteria. Geographical distance from the HRFS, toe systolic pressure (TSP), diabetes and infection were all significantly correlated with LEA and included in the logistic regression model. TSP decrease of 1 mmHg (OR 1.02, 95% CI 1.01–1.03), increased geographical distance (1 km) from HRFS (OR 1.006, 95% CI 1.001–1.01) infection (OR 2.08, 95% CI 1.06–4.07) and presence of diabetes (OR 3.77, 95%CI 1.12–12.65) were all significantly associated with increased likelihood of LEA. Conclusions: HRFS should account for the disparity in outcomes between patients living in close proximity to their service, compared to those in rural areas. Optimal management of diabetes, vascular perfusion and control of infection may also contribute to preventing LEA in people with active foot ulceration.