The main trends in the surgical practice of lower limb amputations in the Kyrgyz Republic

The purpose of the study: to study the features of the frequency and nature of high amputations performed in the Kyrgyz Republic.

Materials and methods. The statistical indicators of the database "Treated case" of the Compulsory Medical Insurance Fund of the Kyrgyz Republic from January to December 2022 were studied, which included gender, age, ways of hospitalization, main and concomitant diagnoses, duration of hospitalization, duration of stay in the intensive care unit, main and repeated surgical interventions, frequency and structure of complications, outcome.

Research results. In the Kyrgyz Republic, from January 1 to December 31, 2022, amputations of the lower extremities were performed in 923 patients. Of these, 41.5 % are women, 58.5 % are men. By age, there was a predominance of elderly (36.7 ± 1.6%) and middle-aged (35.5 ± 1.6%), less senile (14.1 ± 1.1%) and young (13.7 ± 1.1%). The main causes of amputations were complicated forms of diabetic foot syndrome (65.7 %), less often vascular diseases without diabetes mellitus (18.3 %) and other causes: injuries, purulent bone diseases and others (16.0 %). The average duration of hospitalization was 13.4 ± 1.8 days. High amputations were performed in 34.1 %, and small amputations in 65.9 % of cases. The ratio of transtibial to transfemoral amputations was 1 : 9.1. Reamputations in the early postoperative period after high amputations were performed in 8.6% of cases due to the development of purulent necrotic complications. The mortality rate for all amputations in the early postoperative period was 2.3 %, and in the group of patients after high amputations, the mortality rate was 7.7 times higher (5.4 %) than after small amputations.

Conclusions. The high proportion of high amputations in patients of working age, mainly due to purulent-necrotic complications of diabetic foot syndrome, confirms the high social significance of the medical problem. The predominance of transfemoral amputations over transtibial amputations in the structure of high amputations, the high proportion of reamputations in the early postoperative period indicates the need to develop and implement a strategy for surgical treatment of purulent necrotic lesions of the lower extremities in patients with diabetes mellitus and in its absence.

1. Bakker K., Apelqvist J., Lipsky B. A., et al. Guidelines and documents of the International Diabetic Foot Group 2015 on the prevention and treatment of foot diseases in diabetes: reaching an evidence based consensus (abridged Russian version, translated under the general editorship of. I. V. Gurie va) = Bakker K., Apel’kvist Dzh., Lipski B. A. i dr. Rukovodstvo i dokumenty Mezhdunarodnoy gruppy po diabeticheskoy stope 2015 po profilaktike i lecheniyu zabolevaniy stopy pri diabete: dostizheniye dokazatel’nogo konsensusa (sokrash chennaya russkoyazychnaya versiya, perevod pod obshch. red. I. V. Gur’yevoy). Rany i ranevyye in fektsii. Zhurnal imeni prof. B.M. Kostyuchonka. 2016; 3 (2): 59–70. (In Russ).

2. Mit ish V. A., Paskhalova Yu. S., Ushakov A. A., et al. High amputations of the lower extremities in gangrene = Mitish V. A., Paskhalova Yu. S., Ushakov A. A. i dr. Vysokiye amputatsii nizhnikh konech nostey pri gangrene. Sbornik nauchnykh trudovMezhdunarodnoy nauchno-prakticheskoy konferentsii “Vysokiye amputatsii nizhnikh konechnostey u detey i vzroslykh”. M., 2019. S. 93–96. (In Russ).]

3. Калинин А. П., Рафибеков Д. С., Ахунбаев М. И. Диабетическая стопа. Бишкек, 2000. [Kalinin A. P., Rafibekov D. S., Akhunbaev M. I. Diabetic foot = Kalinin A. P., Rafibekov D. S., Akhunbayev M. I. Diabetiches kaya stopa. Bishkek, 2000. (In Russ).

4. Pirogov N. I. Beginnings of general military field surgery = Pirogov N. I. Nachala obshchey voyenno polevoy khirurgii. M.-L., 1941–1944. Ch. 1–2. (In Russ).

5. Jones W. S., Patel M. R., Dai D., et al. High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. Am Heart J. 2013; 165 (5): 809 815.e1.

6. Van D. H., Boesmans E., Defraigne J. O. Acute limb ischemia. Rev Med Liege. 2018; 73 (5-6): 304–311.

7. Simon F., Oberhuber A., Floros N., et al. Acute limb ischemia-much more than just a lack of oxygen. Int J Mol Sci. 2018; 19 (2): 374.

8. Chernyad’ev S. A., Pogosian V. A., Fadin B. V. Lower limb amputation. Clinical and Experimental Surgery = Chernyad’yev S. A., Pogosyan V. A., Fadin B. V. Amputatsii nizhnikh konechnostey. Klinicheskaya i eksperimental’naya khirurgiya. Zhurnal imeni akademika B.V. Petrovskogo. 2022; 10 (2): 54–59. (In Russ).

9. CEZ under the Ministry of Health of the Kyrgyz Republic — Center for Electronic Healthcare under the Ministry of Health of the Kyrgyz Republic = TSEZ pri MZ KR — Tsentr Elektronnogo Zdravookhraneniya pri Ministerstve Zdravookhraneniya Kyrgyzskoy Respubliki. (In Russ). [cited 17.01.2026]. Available from: https://cez.med.kg.

10. Mitish V. A., Svetukhin A. M., Chupin A. V. Method of amputation of the lower leg in conditions of critical ischemia of the lower extremities = Mitish V. A., Svetukhin A. M., Chu pin A. V. Sposob amputatsii goleni v usloviyakh kriticheskoy ishemii nizhnikh konechnostey. Angi ologiya i sosudistaya khirurgiya. 1997; 97 (4): 96–102. (In Russ).

11. Grekova N. M., Lebedeva Yu. V., Shishmentsev N. B., Diner man G. V. Ways to reduce the frequency of high amputations in diabetes mellitus and prognosis for operated diabetic foot = Grekova N. M., Lebedeva Yu. V., Shishmentsev N. B., Dinerman G. V. Putisnizheniya chastoty vysokikh amputatsiy pri sakharnom diabete i prognoz dlya operirovannoy diabeticheskoy stopy. Sovremennyye problemy nauki i obrazovaniya. 2017; (5): 5. (In Russ).

12. Bens man V. M., Baryshev A. G., Pyatakov S. N., et al. Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome = Bensman V. M., Bary shev A. G., Pyatakov S. N. i dr. Puti snizheniya chastoty vysokikh amputatsiy, postamputatsion nykh oslozhneniy i letal’nosti pri sindrome diabeticheskoy stopy. Rany i ranevyye infektsii. Zhurnal im. prof. B. M. Kostyuchonka. 2021; 8 (1): 12–23. (In Russ).

13. Mula tov A. A., Danilova V. Yu., Mayrukov A. N. Purulent-necrotic lesions of the amputation stump in patients with diabetes mellitus in the Chuvash Republic = Mulatov A. A., Danilo va V. Yu., Mayrukov A. N. Gnoyno-nek roticheskiye porazheniya amputatsionnoy kul’ti u patsiyentov s sakharnym diabetom v Chuvashskoy Respublike. Mezhdunarodnyy studencheskiy nauchnyy vestnik. 2018; (1): 10. (In Russ).

14. Kaliev M. T., Imankulova A. S., Djumalieva G. A., et al. The classifier of surgical operations and manipulations in system of medical services financing in the Kyrgyz Republic = Kaliyev M. T., Imankulova A. S., Dzhumaliyeva G. A. i dr. Klassifikator khirurgicheskikh operatsiy i manipulyatsiy v sisteme finansirovaniya medit sinskikh uslug v Kyrgyzskoy Respublike. Problemy sotsial’noy gigiyeny, zdravookhraneniya i istorii meditsiny. 2022; 30 (2): 318–321. (In Russ).