Preanesthetic mortality prediction in diabetics undergoing major lower limb amputation at a tertiary referral hospital: Implications of preoperative echocardiographic and laboratory values

Abstract

Purpose: 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. (C) 2015 Elsevier Inc. All rights reserved.