Title : Psychological comorbidities following below-knee amputation: A retrospective database comparison of diabetic and trauma patients
Abstract:
Below the knee amputations (BKAs) are performed in trauma and diabetic patients where limb damage is too severe to be salvaged and is potentially life-threatening. However, patients face several mental and physical challenges post-BKA. Both trauma and diabetic patients experience significant psychological burdens after BKAs. This study looked at the development of psychiatric conditions including suicidal ideations, post-traumatic stress disorder, phantom limb syndrome, and death among trauma versus diabetic patients post-BKA.
TriNetX, a multinational network of electronic health records was used to identify patients between 18-80 years old who were diagnosed with diabetes mellitus and underwent lower limb amputation procedures (Cohort 1) and patients who underwent traumatic amputation of the lower limb and underwent lower limb amputation procedures (Cohort 2). Outcomes of interest were suicidal ideations, post-traumatic stress disorder (PTSD), phantom limb syndrome, and whether the patient was deceased. Risk, risk ratio, odds ratio and a Kaplan-Meier survival analysis were calculated to examine the difference between the two cohorts in developing various psychiatric comorbidities post-operatively.
After propensity matching, each cohort had 2,336 patients. Demographics were well-balanced across the two cohorts. Patients with diabetes mellitus and BKA were at a higher risk for suicidal ideations and experienced these events earlier than trauma patients. Diabetic patients post-BKA were also at higher risk for death and experienced death earlier than trauma patients. Conversely, patients who underwent traumatic amputations were at higher risk for PTSD and experienced it earlier than diabetic patients. Trauma patients post-BKA were at higher risk for phantom limb syndrome and tended to experience it earlier than diabetic patients.
The findings from this study suggest that BKAs are associated with various psychological comorbidities, as indicated by prior relevant literature. Of note, BKAs in diabetic vs trauma patients were associated with different psychological conditions. These results highlight the importance of addressing potential mental health conditions in patients undergoing limb amputations. Furthermore, these findings demonstrate that certain psychological conditions tend to align with different patient populations undergoing amputations. Physicians may use this data to tailor their approach to caring for patients undergoing lower limb amputations.
