The profile of geriatric extremity amputation in a low-and-middle-income country

Abstract

Background: Despite advances in medical care and diagnosis, patients, particularly in low-and middle-income countries, continue to present with avoidable indications for amputation. Limb amputation is a substantial healthcare burden, especially in elderly individuals, as they tend to have comorbidities that either contribute to amputation or complicate their management.

Objective: This study aims to profile geriatrics that had extremity amputations and determine the causes and risk factors.

Methods: The study was a ten-year retrospective review of patients aged 65 years and above with amputation. Data were analyzed using SPSS version 26.

Results: A total of 124 patients were recruited. Males were 66(53.2%) and females were 58(46.8%). The mean age was 73.65 (SD=6.86) years. Diabetic foot disease was the leading cause of geriatric extremity amputations, occurring in 75 (60.48%) of the patients and the risk factors include poor glycaemic control, infections, peripheral neuropathy, and trivial traumas. Most patients presented late, with a median symptom duration of 30 days (maximum = 10950 and minimum = 1 day) before hospital presentation. Wagner grade 4 (N=58) (46.77%) was the commonest grade of diabetic foot ulcer noted. About 80% of patients had one or more comorbidities, with hypertension and diabetes mellitus predominating. Microscopic proteinuria was recorded on urinalysis in 35(28.23%) patients, suggesting coexisting renal dysfunction. Twenty-nine patients (23.39%) had a significant surgical history, with previous limb amputation 13 (10.49%) being the most common surgical procedure. Below-knee amputation 72 (58.06%) was the commonest type in the study. Most patients (101 = 81.45%) had no complications following amputation, with 67(54.03%) discharged on a wheelchair.

Conclusions: This study found diabetic foot gangrene to be the leading cause of geriatric extremity amputations, with hypertension and diabetes mellitus the commonest comorbidities. It also found late presentation to be a common problem in these patients, with most patients presenting elsewhere first.