Predictive Laboratory Findings of Lower Extremity Amputation in Diabetic Patients: Meta-analysis

Lower extremity amputation is a source of morbidity and mortality among diabetic patients. This meta-analysis aimed to identify significant laboratory data in patients with diabetic foot ulcer with high rates of lower extremity amputation. We performed a systematic literature review and meta-analysis using MEDLINE, EMBASE, and Cochrane databases. We extracted and evaluated 11 variables from the included studies based on amputation rates. This study used the Newcastle-Ottawa Scale to assess the quality of the studies. The search strategy identified 101 publications from which we selected 16 articles for review. We identified HbA1c, fasting blood glucose, white blood cells, C-reactive protein, and erythrocyte sedimentation rate as predictive variables of higher major amputation rate. Although further investigation of long-term and prospective studies is needed, we identified 5 variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.

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Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures: Evidence from a cohort of a half-million diabetic patients

Diabetes Care ◽

10.2337/dc06-1343 ◽

2006 ◽

Vol 29 (11) ◽

pp. 2409-2414 ◽

Cited By ~ 75

Author(s):

H.-F. Chen ◽

C.-A. Ho ◽

C.-Y. Li

Keyword(s):

Lower Extremity ◽

Lower Extremity Amputation ◽

Diabetic Patients ◽

Revascularization Procedures ◽

Extremity Amputation ◽

Age And Sex

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Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392817721109 ◽

2017 ◽

Vol 4 ◽

pp. 233339281772110 ◽

Cited By ~ 2

Author(s):

Andrea L. Lorden ◽

Luohua Jiang ◽

Tiffany A. Radcliff ◽

Kathleen A. Kelly ◽

Robert L. Ohsfeldt

Keyword(s):

Clostridium Difficile ◽

Lower Extremity ◽

Clostridium Difficile Infection ◽

Lower Extremity Amputation ◽

Diabetic Patients ◽

Healthcare Associated Infections ◽

Preventable Hospitalizations ◽

Potentially Preventable Hospitalizations ◽

Healthcare Associated ◽

Extremity Amputation

Background: An estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs) and accounted for $9.8 (USD) billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs) may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events. Aims: To estimate the period occurrences and likelihood of acquiring an HAI for the PPH population. Methods: Retrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics. Findings: We identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91) for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant. Conclusions: Clinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements.

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Amputation and reamputation of the diabetic foot

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-87-6-255 ◽

1997 ◽

Vol 87 (6) ◽

pp. 255-259 ◽

Cited By ~ 104

Author(s):

DG Armstrong ◽

LA Lavery ◽

LB Harkless ◽

WH Van Houtum

Keyword(s):

Lower Extremity ◽

Previous History ◽

Arterial Disease ◽

Lower Extremity Amputation ◽

South Texas ◽

Diabetic Patients ◽

Amputation Level ◽

Causal Pathway ◽

Peripheral Arterial ◽

Extremity Amputation

The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations.

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Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death

Foot & Ankle Specialist ◽

10.1177/1938640017694722 ◽

2017 ◽

Vol 11 (1) ◽

pp. 17-21 ◽

Cited By ~ 41

Author(s):

Dane K. Wukich ◽

Katherine M. Raspovic ◽

Natalie C. Suder

Keyword(s):

Lower Extremity ◽

Diabetic Foot ◽

Lower Extremity Amputation ◽

Controlled Study ◽

Control Group ◽

Diabetic Patients ◽

Charcot Neuroarthropathy ◽

Diabetic Foot Disease ◽

Foot Disease ◽

Extremity Amputation

Background. The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. Methods. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non–diabetes-related foot pathology. Results. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Conclusion. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Levels of Evidence: Level II: Prospective, Case controlled study

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Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas

Journal of the American Heart Association ◽

10.1161/jaha.121.021456 ◽

2021 ◽

Vol 10 (17) ◽

Author(s):

Alexander C. Fanaroff ◽

Lin Yang ◽

Ashwin S. Nathan ◽

Sameed Ahmed M. Khatana ◽

Howard Julien ◽

...

Keyword(s):

Socioeconomic Status ◽

Lower Extremity ◽

Metropolitan Areas ◽

Major Amputation ◽

Lower Extremity Amputation ◽

Amputation Rate ◽

Peripheral Artery ◽

Artery Disease ◽

Zip Code ◽

Extremity Amputation

Background Rates of major lower extremity amputation in patients with peripheral artery disease are higher in rural communities with markers of low socioeconomic status, but most Americans live in metropolitan areas. Whether amputation rates vary within US metropolitan areas is unclear, as are characteristics of high amputation rate urban communities. Methods and Results We estimated rates of major lower extremity amputation per 100 000 Medicare beneficiaries between 2010 and 2018 at the ZIP code level among ZIP codes with ≥100 beneficiaries. We described demographic characteristics of high and low amputation ZIP codes, and the association between major amputation rate and 3 ZIP code–level markers of socioeconomic status—the proportion of patients with dual eligibility for Medicaid, median household income, and Distressed Communities Index score—for metropolitan, micropolitan, and rural ZIP code cohorts. Between 2010 and 2018, 188 995 Medicare fee‐for‐service patients living in 31 391 ZIP codes with ≥100 beneficiaries had a major lower extremity amputation. The median (interquartile range) ZIP code–level number of amputations per 100 000 beneficiaries was 262 (75–469). Though nonmetropolitan ZIP codes had higher rates of major amputation than metropolitan areas, 78.2% of patients undergoing major amputation lived in metropolitan areas. Compared with ZIP codes with lower amputation rates, top quartile amputation rate ZIP codes had a greater proportion of Black residents (4.4% versus 17.5%, P <0.001). In metropolitan areas, after adjusting for clinical comorbidities and demographics, every $10 000 lower median household income was associated with a 4.4% (95% CI, 3.9–4.8) higher amputation rate, and a 10‐point higher Distressed Communities Index score was associated with a 3.8% (95% CI, 3.4%–4.2%) higher amputation rate; there was no association between the proportion of patients eligible for Medicaid and amputation rate. These findings were comparable to the associations identified across all ZIP codes. Conclusions In metropolitan areas, where most individuals undergoing lower extremity amputation live, markers of lower socioeconomic status and Black race were associated with higher rates of major lower extremity amputation. Development of community‐based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.

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