Risk of major limb amputation in diabetic foot ulcer and accompanying disease: A meta-analysis

Shin, Jin Yong; Roh, Si-Gyun; Sharaf, Basel; Lee, Nae-Ho

doi:10.1016/j.bjps.2017.07.015

Cited by 45 publications

(43 citation statements)

References 32 publications

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“…Arterial insufficiency increases the risk of amputation by prolonging the healing process . Although PAD and the severity of infection posed a greater risk for a high amputation rate, peripheral neuropathy was not an important factor in some of the studies . We confirmed the lack of a significant association between extremity amputation and peripheral neuropathy.…”

Section: Discussionsupporting

confidence: 69%

“…Diabetic complications, including PAD, peripheral neuropathy, nephropathy, and severe infection, were identified as major causes of amputation . Arterial insufficiency increases the risk of amputation by prolonging the healing process .…”

Section: Discussionmentioning

confidence: 99%

“…Diabetic complications, including PAD, peripheral neuropathy, nephropathy, and severe infection, were identified as major causes of amputation. 1,11,23,28,32 Arterial insufficiency increases the risk of amputation by prolonging the healing process. 25 Although PAD and the severity of infection posed a greater risk for a high amputation rate, peripheral neuropathy was not an important factor in some of the studies.…”

Section: Meta-analysis Of the Clinical Findingsmentioning

confidence: 99%

“…1 The World Health Organization has reported that the estimated number of patients with diabetes was nearly 425 million in 2017, consequently, increasing the number of diabetes-related complications. 1,2 These complications lead to decreased quality of life and increased financial costs, morbidity, and even mortality. 3 The cost of diabetic foot complications has been reported to be higher than the cost of treatment for many types of cancer.…”

Section: Introductionmentioning

confidence: 99%

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Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen

Demırdal

Emir

2019

Diabetes Metabolism Res

127

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Background Knowledge of risk factors is crucial to develop management and treatment protocols for the prevention of lower extremity amputation for patients with diabetic foot infections (DFIs). Methods We searched the research literature for studies reporting risk factors for lower extremity amputation in patients with DFI. The main outcome variables included both minor and major amputations. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42018118543). Results A total of 2471 potential articles from the database search met the inclusion criteria. After reviewing the titles, abstracts, and full texts, remaining 25 articles were included in the final analysis. We identified 6132 patients with DFI in the 25 included articles. Of these, 1873 patients who underwent amputation were investigated. Male gender (odds ratio [OR]: 1.31), smoking (OR: 1.38), history of amputation (OR: 1.47), history of osteomyelitis (OR: 1.94), peripheral arterial disease (OR: 2.35), retinopathy (OR: 1.32), International Working Group on the Diabetic Foot (IWGDF) grades 3 and 4 (OR: 1.7 and 2.5), Wagner grades 4 and 5 (OR: 4.3 and 6.4), gangrene/necrosis (OR: 9.9), osteomyelitis (OR: 4.5), neuroischaemic DFI (OR: 3.06), severe infection (OR: 3.12), length of hospitalization (standardized mean difference [SMD]: 0.7), leukocytosis (OR: 1.76), mean erythrocyte sedimentation rate (ESR) (SMD: 0.5), mean C‐reactive protein (CRP) (SMD: 0.8), tissue culture positivity (OR: 1.61), and isolation of Gram‐negative bacteria from tissue culture (OR: 1.5) were found as predictors of amputation in DFI. Conclusions The present study highlighted some differences in diabetic foot ulcers and DFIs in terms of risk factors for lower extremity amputation. These data provide detailed information about risk factors for amputations among patients with DFI, thus contributing to the creation of new classification systems for assessment of high‐risk patients.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Meta-analysis Of the Clinical Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen

Demırdal

Emir

2019

Diabetes Metabolism Res

127

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“…DFUs and LEAs contribute to the development of further deformities and alter the foot pressures leading on to re‐ulceration . PVD is an important risk factor for LEA . The 22‐year prospective Seattle diabetic foot study showed that arterial disease and neuropathy are the only limb‐specific risk factors for LEA .…”

Section: Discussionmentioning

confidence: 99%

Amputations in patients with diabetic foot ulcer: a retrospective study from a single centre in the Northern Territory of Australia

Jeyaraman

Berhane

Hamilton

et al. 2019

ANZ Journal of Surgery

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Background Lower extremity amputations (LEAs) in diabetic patients are common in the indigenous population. There is no published data from the Northern Territory. Methods All patients with diabetic foot ulcer, presenting for the first time to the multi‐disciplinary foot clinic at Royal Darwin Hospital, between January 2003 and June 2015, were included. These patients were followed until 2017, or death. LEA rates over the follow‐up period and the risk factors were studied. Results Of the 513 included patients, 62.8% were males and 48.2% were indigenous. The majority (93.6%) had type 2 diabetes with median diabetes duration of 7.0 years (interquartile range 3–12). During the follow‐up period of 5.8 years (interquartile range 3.1–9.8), a total of 435 LEAs (16.6% major; 34.7% minor) occurred in 263 patients (mean age 57.0 ± 11.8 years). In multivariate analysis, the following variables were associated with LEAs (adjusted odds ratio (95% confidence interval)): prior LEA (4.49 (1.69–11.9)); peripheral vascular disease (2.67 (1.27–5.59)); forefoot ulcer (7.72 (2.61–22.7)); Wagner grade 2 (3.71 (1.87–7.36)); and Wagner grade 3 (17.02 (3.77–76.72)). Indigenous patients were 1.8 times more likely to have LEAs than non‐indigenous patients. Indigenous amputees were approximately 9 years younger than their non‐indigenous counterparts. Conclusion Half of patients presenting with diabetic foot ulcer had LEA during follow‐up. Prior LEAs, peripheral vascular disease, forefoot ulcers and higher Wagner grades were independent risk factors for LEA. Indigenous patients were at higher risk for LEAs and were younger at the time of amputation.

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Epidemiology and Economic Impact of Foot Ulcers

Boyko

Monteiro‐Soares

2020

The Foot in Diabetes

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Risk of major limb amputation in diabetic foot ulcer and accompanying disease: A meta-analysis

Cited by 45 publications

References 32 publications

Meta‐analysis of risk factors for amputation in diabetic foot infections

Meta‐analysis of risk factors for amputation in diabetic foot infections

Amputations in patients with diabetic foot ulcer: a retrospective study from a single centre in the Northern Territory of Australia

Epidemiology and Economic Impact of Foot Ulcers

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