Rathnayake A, Saboo A, Malabu UH, Falhammar H. Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review. World J Diabetes 2020; 11(9): 391-399 [PMID: 32994867 DOI: 10.4239/wjd.v11.i9.391]
Corresponding Author of This Article
Ayeshmanthe Rathnayake, MBBS, Doctor, Department of Medicine, Townsville University Hospital, 100 Angus Smith Drive, Townsville 4817, Queensland, Australia. ayeshmantherathnayake@gmail.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Sep 15, 2020; 11(9): 391-399 Published online Sep 15, 2020. doi: 10.4239/wjd.v11.i9.391
Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review
Ayeshmanthe Rathnayake, Apoorva Saboo, Usman H Malabu, Henrik Falhammar
Ayeshmanthe Rathnayake, Apoorva Saboo, Usman H Malabu, Usman H Malabu, Department of Medicine, Townsville University Hospital, Townsville 4814, Queensland, Australia
Usman H Malabu, School of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland, Australia
Henrik Falhammar, Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm 17176, Sweden
Henrik Falhammar, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 17176, Sweden
Author contributions: Rathnayake A contributed to acquisition of data, analysis and interpretation of data, drafting the article; Saboo A contributed to acquisition of data, analysis and interpretation of data, drafting the article; Malabu U contributed to interpretation of data, revising the article, final approval; Falhammar H contributed to interpretation of data, revising the article, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ayeshmanthe Rathnayake, MBBS, Doctor, Department of Medicine, Townsville University Hospital, 100 Angus Smith Drive, Townsville 4817, Queensland, Australia. ayeshmantherathnayake@gmail.com
Received: May 7, 2020 Peer-review started: May 7, 2020 First decision: May 24, 2020 Revised: June 6, 2020 Accepted: August 15, 2020 Article in press: August 15, 2020 Published online: September 15, 2020 Processing time: 127 Days and 5.3 Hours
Abstract
BACKGROUND
Diabetes mellitus causes a large majority of non-traumatic major and minor amputations globally. Patients with diabetes are clinically complex with a multifactorial association between diabetic foot ulcers (DFU) and subsequent lower extremity amputations (LEA). Few studies show the long-term outcomes within the cohort of DFU-associated LEA.
AIM
To highlight the long-term outcomes of LEA as a result of DFU.
METHODS
PubMed/MEDLINE and Google Scholar were searched for key terms, “diabetes”, “foot ulcers”, “amputations” and “outcomes”. Outcomes such as mortality, re-amputation, re-ulceration and functional impact were recorded. Peer-reviewed studies with adult patients who had DFU, subsequent amputation and follow up of at least 1 year were included. Non-English language articles or studies involving children were excluded.
RESULTS
A total of 22 publications with a total of 2334 patients were selected against the inclusion criteria for review. The weighted mean of re-amputation was 20.14%, 29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively with significantly higher rates associated with major amputation, re-amputation and ischemic cardiomyopathy.
CONCLUSION
Previous LEA, level of the LEA and patient comorbidities were significant risk factors contributing to re-ulceration, re-amputation, mortality and depreciated functional status.
Core Tip: There was a significantly higher degree of re-amputation and mortality in those who undergo amputations due to diabetic foot ulcers in addition to impact on quality of life. Data on long-term outcomes in these patients were limited and requires further research to better understand the long-term outcomes in this subset of patients.
