Timing of minor and major amputation in patients with diabetes‐related foot ulceration admitted to two public tertiary referral hospitals in Australia

Manewell, Sarah M; Aitken, Sarah; Nubé, Vanessa L; Crawford, Anna; Constantino, Maria; Twigg, Stephen M.; Menz, Hylton B.; Sherrington, Catherine; Paul, Serene S.

doi:10.1111/ans.18224

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…The included studies collectively comprised 5689 patients. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Among them, 1815 cases were in the DFU amputation group, while 3874 cases were in the DFU non‐amputation group. The selected literature, based on the NOS method, had quality scores of 6 or above, including six prospective cohort studies and 10 retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

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The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta‐analysis

Luo,

Liu,

et al. 2024

International Wound Journal

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This study analysed the incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers. This study systematically searched both Chinese and English databases, including CNKI, Wanfang, VIP, PubMed, EMBASE and Web of Science, to identify cohort studies related to lower extremity amputation and associated risk factors in patients with diabetic foot ulcers up to October 2023. The patients were stratified based on whether they underwent lower extremity amputation, and relevant data, including basic information, patient characteristics, complications, comorbidities and pertinent laboratory test data, were extracted from the included studies. The literature quality assessment in this study utilized the Newcastle‐Ottawa Scale to screen for high‐quality literature, resulting in the inclusion of 16 cohort studies, all of which were of at least moderate quality. Meta‐analysis of outcome indicators was conducted using the Stata 14.0 software. The results indicate that the overall amputation rate of lower extremities in patients with diabetic foot ulcers is 31% (0.25, 0.38). Among the 16 variables evaluated, gender (male), smoking history, body mass index (BMI), hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels were found to be correlated with the occurrence of lower extremity amputation in patients with diabetic foot ulcers. However, no significant correlation was observed between age, diabetes type, duration of diabetes, stroke, glycosylated haemoglobin, creatinine and total cholesterol levels and lower extremity amputation in patients with diabetic foot ulcers. This meta‐analysis indicates that the overall amputation rate in patients with diabetic foot ulcers is 31%. Factors such as gender (male), smoking history, high BMI, hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels are identified as significant risk factors for lower extremity amputation in diabetic foot ulcer patients. These findings suggest that attention should be focused on these risk factors in patients with diabetic foot ulcers to reduce the risk of lower extremity amputation. Therefore, preventive and intervention measures targeting these risk factors are of significant importance in clinical practice. (Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42024497538]).

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Section: Resultsmentioning

confidence: 99%

“…After excluding duplicates, irrelevant studies and those not meeting the PICOS criteria, our study ultimately included 16 cohort studies (Figure 1). The included studies collectively comprised 5689 patients 13–28 . Among them, 1815 cases were in the DFU amputation group, while 3874 cases were in the DFU non‐amputation group.…”

Section: Resultsmentioning

confidence: 99%

The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta‐analysis

Luo,

Liu,

et al. 2024

International Wound Journal

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“…A total of 32 publications from a total of 3245 connected investigations that were examined that met the inclusion criteria and were published between 1998 and 2023 were chosen and included in the study 10‐41 . The results of these researches are presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…In studies that were considered for the meta‐analysis, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA 10‐41 . Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs.…”

Section: Discussionmentioning

confidence: 99%

Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta‐analysis

Zhang

Huang

Bai

et al. 2023

International Wound Journal

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A meta‐analysis study was conducted to measure the consequence of diabetic foot ulcers (DFUs) and other risk factors (RFs) on the prevalence of lower extremity amputation (LEA). A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. Of the 32 chosen studies enclosed, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of DFUs and other RFs on the prevalence of LEA by the continuous and dichotomous approaches and a fixed or random effect model. Male gender (OR, 1.30; 95% CI, 1.17–1.44, P < .001), smoking (OR, 1.24; 95% CI, 1.01–1.53, P = .04), previous foot ulcer (OR, 2.69; 95% CI, 1.93–3.74, P < .001), osteomyelitis (OR, 3.87; 95% CI, 2.28–6.57, P < .001), gangrene (OR, 14.45; 95% CI, 7.03–29.72, P < .001), hypertension (OR, 1.17; 95% CI, 1.03–1.33, P = .01), and white blood cells count (WBCC) (MD, 2.05; 95% CI, 1.37–2.74, P < .001) were significantly shown to be an RF in LEA in subjects with DFUs. Age (MD, 0.81; 95% CI, −0.75 to 2.37, P = .31), body mass index (MD, −0.55; 95% CI, −1.15 to 0.05, P = .07), diabetes mellitus type (OR, 0.99; 95% CI, 0.63–1.56, P = .96), and glycated haemoglobin (MD, 0.33; 95% CI, −0.15 to 0.81, P = .17) were not shown to be an RF in LEA in subjects with DFUs. Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs. However, age and diabetes mellitus type were not shown to be RF in LEA in subjects with DFUs. However, caused of the small sample sizes of several chosen studies for this meta‐analysis, care must be exercised when dealing with its values.

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Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study

Bandeira,

Macedo,

Lázaro-Martinez

et al. 2024

The International Journal of Lower Extremity Wounds

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The aim of this study was to identify and analyze the incidence rate of amputations and their risk factors in people with Diabetes Mellitus (DM) in two specialized outpatient clinics in Brazil. This is an epidemiological, retrospective cohort study using data collected from electronic health records of 281 adult diabetic patient types 1 or 2; attended in specialized outpatient service between 2015 and 2020. Statistical analyses were performed using the 2 sample t-test or Wilcoxon–Mann–Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the risk factors for amputation was carried out through logistic regression. The study was approved by ethical committee. The sample mean age was 65.6 years (SD 13.05), predominating male gender n = 211 (75%), type 2 DM n = 223 (86.7%), with cardiovascular disease n = 143 (63.2%), and about 68.7% (n = 156) with peripheral arterial disease (PAD). Seventy-seven had lower limb amputation (LLA), with a rate incidence of 31.9% during five years. Logistic regression analysis showed the following associations with amputation: Diabetic peripheral neuropathy increased the rate of amputation by 3.6 times (OR = 3.631, 95% CI = 1.214-11.353; P = .022), and peripheral arterial disease increased by 10 times (OR = 10.631; 95% CI = 2.969-57.029; P = .001). The LLA in individuals with DM in two specialized outpatient services was higher compared to international literature; DPN and PAD were confirmed as risk factors for amputation, according to literature. This finding suggests that the study population faces an increased risk of amputation, highlighting the urgent need for targeted interventions and implementing robust preventive strategies to transform the current scenario and mitigate these severe outcomes. A comprehensive approach is essential to proactively address the underlying issues and reduce the prevalence and impact of amputations in Brazil.

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Timing of minor and major amputation in patients with diabetes‐related foot ulceration admitted to two public tertiary referral hospitals in Australia

Cited by 4 publications

References 22 publications

The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta‐analysis

The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta‐analysis

Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta‐analysis

Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study

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