Inpatients with Chronic Lower Extremity Wounds Often Present with Advanced Disease and Carry a High Risk of Lower Extremity Amputation
Gloria Sanin, Lucas Hunter, Gabriella Velazquez, Maureen Sheehan, Timothy Craven, Matthew Edwards, Matthew P Goldman
Wake Forest University, Winston Salem, NC
INTRODUCTION: Chronic lower extremity wounds are a significant cause of hospitalization and readmissions. With increasing prevalence of risk factors, the burden of lower extremity wounds continues to grow. Patients are often presenting to inpatient settings with advanced disease. In this study we evaluate outcomes of patients admitted to a tertiary center who are managed by our limb preservation service (FLEX). METHODS: Patients referred to the inpatient FLEX service were included in the study. Admission data including WiFi stage, etiology of disease, and ankle brachial index (ABI) were collected. Outcomes, including major adverse limb events were evaluated using logistic regression models. RESULTS: 588 patients were included. Mean age was 64 years, 37% were female, and 30% were black. 64% of patients were diabetic and 66% were current/former smokers. 32% underwent a major/minor amputation. Mean ankle brachial index (ABI) was 0.90 and mean toe pressure was 80.4 mmHg. 57% of patients presented with WiFi clinical stage 3 or 4 (risk of amputation) and 42% presented with WiFi stage 3 or 4 (risk of revascularization). Univariate analysis found increasing WiFi stage (p<0.0001), hyperlipidemia (OR 3.11; 95% CI 1.55-6.22), diabetes (OR 1.87; 95% CI 1.27-2.74), end stage renal disease (OR 2.26; 95% CI 1.28-3.99), hypertension (OR 1.69; 95% CI 1.17-2.43) and Hemoglobin A1c (OR 1.23; 95% CI 1.02-1.49) were associated with increased risk of lower extremity amputation. In multivariate models, In multivariate models, WiFi stage 3 and 4 were significant predictors for amputation (OR 9.3 and 13.2 respectively; P<0.01). The presence of diabetes (OR 2.99;P=0.0004) was also predictive of amputation in multivariate models. CONCLUSIONS:Inpatients who are admitted with chronic lower extremity wounds often present with advanced disease and are at high risk for minor and major limb amputations. In the inpatient setting aggressive multimodality therapy is likely required to help with limb salvage in patients with chronic lower extremity wounds.
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