PDF(Pubmed)
Abstract：
BACKGROUND: Minor amputation is commonly needed to treat diabetes-related foot disease (DFD). Remoteness of residence is known to limit access to healthcare and has previously been associated with poor outcomes. The primary aim of this study was to examine the associations between ethnicity and remoteness of residency with the risk of major amputation and death following initial treatment of DFD by minor amputation. A secondary aim was to identify risk factors for major amputation and death following minor amputation to treat DFD.
METHODS: This was a retrospective analysis of data from patients who required a minor amputation to treat DFD between 2000 and 2019 at a regional tertiary hospital in Queensland, Australia. Baseline characteristics were collected together with remoteness of residence and ethnicity. Remoteness was classified according to the 2019 Modified Monash Model (MMM) system. Ethnicity was based on self-identification as an Aboriginal and Torres Strait Islander or non-Indigenous person. The outcomes of major amputation, repeat minor amputation and death were examined using Cox-proportional hazard analyses.
RESULTS: A total of 534 participants were included, with 306 (57.3%) residing in metropolitan or regional centres, 228 (42.7%) in rural and remote communities and 144 (27.0%) were Aboriginal or Torres Strait Islander people. During a median (inter quartile range) follow-up of 4.0 (2.1-7.6) years, 103 participants (19.3%) had major amputation, 230 (43.1%) had repeat minor amputation and 250 (46.8%) died. The risks (hazard ratio [95% CI]) of major amputation and death were not significantly higher in participants residing in rural and remote areas (0.97, 0.67-1.47; and 0.98, 0.76-1.26) or in Aboriginal or Torres Strait Islander people (HR 1.44, 95% CI 0.96, 2.16 and HR 0.89, 95% CI 0.67, 1.18). Ischemic heart disease (IHD), peripheral artery disease (PAD), osteomyelitis and foot ulceration (p<0.001 in all instances) were independent risk factors for major amputation.
CONCLUSIONS: Major amputation and death are common following minor amputation to treat DFD and people with IHD, PAD and osteomyelitis have an increased risk of major amputation. Aboriginal and Torres Strait Islander People and residents of remote areas were not at excess risk of major amputation.
METHODS: This was a retrospective analysis of data from patients who required a minor amputation to treat DFD between 2000 and 2019 at a regional tertiary hospital in Queensland, Australia. Baseline characteristics were collected together with remoteness of residence and ethnicity. Remoteness was classified according to the 2019 Modified Monash Model (MMM) system. Ethnicity was based on self-identification as an Aboriginal and Torres Strait Islander or non-Indigenous person. The outcomes of major amputation, repeat minor amputation and death were examined using Cox-proportional hazard analyses.
RESULTS: A total of 534 participants were included, with 306 (57.3%) residing in metropolitan or regional centres, 228 (42.7%) in rural and remote communities and 144 (27.0%) were Aboriginal or Torres Strait Islander people. During a median (inter quartile range) follow-up of 4.0 (2.1-7.6) years, 103 participants (19.3%) had major amputation, 230 (43.1%) had repeat minor amputation and 250 (46.8%) died. The risks (hazard ratio [95% CI]) of major amputation and death were not significantly higher in participants residing in rural and remote areas (0.97, 0.67-1.47; and 0.98, 0.76-1.26) or in Aboriginal or Torres Strait Islander people (HR 1.44, 95% CI 0.96, 2.16 and HR 0.89, 95% CI 0.67, 1.18). Ischemic heart disease (IHD), peripheral artery disease (PAD), osteomyelitis and foot ulceration (p<0.001 in all instances) were independent risk factors for major amputation.
CONCLUSIONS: Major amputation and death are common following minor amputation to treat DFD and people with IHD, PAD and osteomyelitis have an increased risk of major amputation. Aboriginal and Torres Strait Islander People and residents of remote areas were not at excess risk of major amputation.
摘要：
背景：治疗糖尿病相关的足部疾病（DFD）通常需要小截肢。众所周知，居住的远程限制了人们获得医疗保健的机会，并且以前与不良结果有关。这项研究的主要目的是研究种族和居住偏远之间的关系，以及通过轻度截肢初次治疗DFD后发生严重截肢和死亡的风险。次要目的是确定严重截肢和轻微截肢治疗DFD后死亡的危险因素。
方法：这是对昆士兰州一家地区三级医院在2000年至2019年间需要轻微截肢治疗DFD的患者数据的回顾性分析，澳大利亚。收集了基线特征以及居住和种族的偏远性。远程性根据2019年修改的莫纳什模型(MMM)系统进行分类。种族基于土著和托雷斯海峡岛民或非土著人的自我认同。严重截肢的结果，使用Cox比例风险分析检查了重复轻微截肢和死亡.
结果：共纳入534名参与者，306人(57.3%)居住在大都市或地区中心，农村和偏远社区有228人（42.7％），原住民或托雷斯海峡岛民有144人（27.0％）。在4.0（2.1-7.6）年的中位数（四分位数之间）随访期间，103名参与者（19.3%）有严重截肢，230例（43.1％）重复轻微截肢，250例（46.8％）死亡。居住在农村和偏远地区的参与者（0.97，0.67-1.47；和0.98，0.76-1.26）或原住民或托雷斯海峡岛民（HR1.44，95％CI0.96，2.16和HR0.89，95％CI0.67，1.18）的严重截肢和死亡的风险（风险比[95％CI]）没有显着提高。缺血性心脏病（IHD），外周动脉疾病（PAD），骨髓炎和足部溃疡(p<0.001)是严重截肢的独立危险因素.
结论：小截肢治疗DFD和IHD患者后，大截肢和死亡是常见的，PAD和骨髓炎增加了严重截肢的风险。原住民和托雷斯海峡岛民和偏远地区的居民没有严重截肢的风险。
方法：这是对昆士兰州一家地区三级医院在2000年至2019年间需要轻微截肢治疗DFD的患者数据的回顾性分析，澳大利亚。收集了基线特征以及居住和种族的偏远性。远程性根据2019年修改的莫纳什模型(MMM)系统进行分类。种族基于土著和托雷斯海峡岛民或非土著人的自我认同。严重截肢的结果，使用Cox比例风险分析检查了重复轻微截肢和死亡.
结果：共纳入534名参与者，306人(57.3%)居住在大都市或地区中心，农村和偏远社区有228人（42.7％），原住民或托雷斯海峡岛民有144人（27.0％）。在4.0（2.1-7.6）年的中位数（四分位数之间）随访期间，103名参与者（19.3%）有严重截肢，230例（43.1％）重复轻微截肢，250例（46.8％）死亡。居住在农村和偏远地区的参与者（0.97，0.67-1.47；和0.98，0.76-1.26）或原住民或托雷斯海峡岛民（HR1.44，95％CI0.96，2.16和HR0.89，95％CI0.67，1.18）的严重截肢和死亡的风险（风险比[95％CI]）没有显着提高。缺血性心脏病（IHD），外周动脉疾病（PAD），骨髓炎和足部溃疡(p<0.001)是严重截肢的独立危险因素.
结论：小截肢治疗DFD和IHD患者后，大截肢和死亡是常见的，PAD和骨髓炎增加了严重截肢的风险。原住民和托雷斯海峡岛民和偏远地区的居民没有严重截肢的风险。
