Washington University School of Medicine, St. Louis, MO, USA.
Hand (N Y). 2024 Mar;19(2):269-277. doi: 10.1177/15589447221082160. Epub 2022 Mar 14.
Diabetes is a well-established risk factor for severe digital infection, and patients are more likely to require digital amputation for adequate source control. This study aims to identify factors predictive of digital amputation compared with preservation in patients with diabetes who present with surgically treated finger infections.
Current Procedural Terminology (CPT) and International Classification of Diseases Versions 9 and 10 (ICD-9/10) databases from a single academic medical center were queried to identify patients with type 1 or type 2 diabetes mellitus who underwent surgical treatment in the operating room for treatment of a digital infection from 2010 to 2020. Electronic medical records were reviewed to obtain historical and acute clinical variables at the time of hospital presentation. Bivariate and multivariable regression were used to identify factors associated with amputation.
In total, 145 patients (61 digital amputation, 84 digital preservation) met inclusion criteria for this retrospective cohort study. Mean hospital stay was 6 days, and the average patient underwent 2 operations. Multivariable analysis revealed that the presence of osteomyelitis, ipsilateral upper extremity dialysis fistula, end-stage renal disease, and vascular disease each had significant independent predictive value for amputation rather than digital preservation.
Digital amputation is common in the setting of diabetic finger infection. The 4 variables found to independently predict the outcome of amputation can be understood as factors which decrease the likelihood of successful digital salvage and increase the potential consequence of ongoing uncontrolled infection. Further study should focus on clinical factors affecting surgical decision making and how the treatment rendered affects patient outcomes.
糖尿病是严重手部感染的既定危险因素，患者更有可能需要进行手部截肢以充分控制感染源。本研究旨在确定与糖尿病患者手术治疗的手指感染相比，预测手部截肢的因素。
从单一学术医疗中心的当前程序术语 (CPT) 和国际疾病分类第 9 版和第 10 版 (ICD-9/10) 数据库中查询了 2010 年至 2020 年在手术室接受手术治疗手指感染的 1 型或 2 型糖尿病患者。回顾电子病历以获取住院时的历史和急性临床变量。使用二变量和多变量回归来确定与截肢相关的因素。
共有 145 名患者（61 例手部截肢，84 例手部保留）符合本回顾性队列研究的纳入标准。平均住院时间为 6 天，平均每位患者进行了 2 次手术。多变量分析显示，骨髓炎、同侧上肢透析瘘、终末期肾病和血管疾病的存在均与截肢而非手部保留具有显著独立的预测价值。
糖尿病患者手指感染时常见截肢。发现的 4 个独立预测截肢结果的变量可被理解为降低成功保留手指的可能性并增加持续失控感染潜在后果的因素。进一步的研究应侧重于影响手术决策的临床因素以及所提供的治疗如何影响患者的结局。
