The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review

Daniel Jupiter, Jakob C. Thorud, Clifford J. Buckley, Naohiro Shibuya

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

A great deal of emphasis, clinical and financial, is placed on limb salvage efforts in diabetic patients suffering from lower extremity ulceration. This is because of the impression that amputation in such patients may be a proximal cause of death. While amputation is certainly a negative clinical outcome, it is not entirely clear that it causes death. In this systematic review, we examine the available literature to attempt to understand the role that the ulceration itself may play in mortality. In brief, we searched for human studies in OVID, CINAHL and the COCHRANE CENTRAL DATABASE from 1980 to 2013, looking for articles related to ulcer or wound of the foot, in patients with diabetes or peripheral vascular disease, and death. We looked for articles with 5years of follow-up, or Kaplan-Meier estimates of 5-year mortality, and excluded reviews and letters. Articles were assessed for quality and potential bias using the Newcastle-Ottawa scale. We find that while the patient populations studied varied widely in terms of demographics and comorbidities, limiting generalisability, 5-year mortality rates after ulceration were around 40%. Risk factors for death commonly identified were increased age, male gender, peripheral vascular disease and renal disease.

Original languageEnglish (US)
JournalInternational Wound Journal
DOIs
StateAccepted/In press - 2015

Fingerprint

Amputation
Foot
Peripheral Vascular Diseases
Mortality
Cause of Death
Limb Salvage
Kaplan-Meier Estimate
Ulcer
Comorbidity
Lower Extremity
Demography
Kidney
Wounds and Injuries
Population

Keywords

  • Amputation
  • Diabetes
  • Mortality
  • Ulceration

ASJC Scopus subject areas

  • Surgery
  • Dermatology

Cite this

The impact of foot ulceration and amputation on mortality in diabetic patients. I : From ulceration to death, a systematic review. / Jupiter, Daniel; Thorud, Jakob C.; Buckley, Clifford J.; Shibuya, Naohiro.

In: International Wound Journal, 2015.

Research output: Contribution to journalArticle

@article{6b430538a37f4dbe8384e05b2b9ba937,
title = "The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review",
abstract = "A great deal of emphasis, clinical and financial, is placed on limb salvage efforts in diabetic patients suffering from lower extremity ulceration. This is because of the impression that amputation in such patients may be a proximal cause of death. While amputation is certainly a negative clinical outcome, it is not entirely clear that it causes death. In this systematic review, we examine the available literature to attempt to understand the role that the ulceration itself may play in mortality. In brief, we searched for human studies in OVID, CINAHL and the COCHRANE CENTRAL DATABASE from 1980 to 2013, looking for articles related to ulcer or wound of the foot, in patients with diabetes or peripheral vascular disease, and death. We looked for articles with 5years of follow-up, or Kaplan-Meier estimates of 5-year mortality, and excluded reviews and letters. Articles were assessed for quality and potential bias using the Newcastle-Ottawa scale. We find that while the patient populations studied varied widely in terms of demographics and comorbidities, limiting generalisability, 5-year mortality rates after ulceration were around 40{\%}. Risk factors for death commonly identified were increased age, male gender, peripheral vascular disease and renal disease.",
keywords = "Amputation, Diabetes, Mortality, Ulceration",
author = "Daniel Jupiter and Thorud, {Jakob C.} and Buckley, {Clifford J.} and Naohiro Shibuya",
year = "2015",
doi = "10.1111/iwj.12404",
language = "English (US)",
journal = "International Wound Journal",
issn = "1742-4801",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - The impact of foot ulceration and amputation on mortality in diabetic patients. I

T2 - From ulceration to death, a systematic review

AU - Jupiter, Daniel

AU - Thorud, Jakob C.

AU - Buckley, Clifford J.

AU - Shibuya, Naohiro

PY - 2015

Y1 - 2015

N2 - A great deal of emphasis, clinical and financial, is placed on limb salvage efforts in diabetic patients suffering from lower extremity ulceration. This is because of the impression that amputation in such patients may be a proximal cause of death. While amputation is certainly a negative clinical outcome, it is not entirely clear that it causes death. In this systematic review, we examine the available literature to attempt to understand the role that the ulceration itself may play in mortality. In brief, we searched for human studies in OVID, CINAHL and the COCHRANE CENTRAL DATABASE from 1980 to 2013, looking for articles related to ulcer or wound of the foot, in patients with diabetes or peripheral vascular disease, and death. We looked for articles with 5years of follow-up, or Kaplan-Meier estimates of 5-year mortality, and excluded reviews and letters. Articles were assessed for quality and potential bias using the Newcastle-Ottawa scale. We find that while the patient populations studied varied widely in terms of demographics and comorbidities, limiting generalisability, 5-year mortality rates after ulceration were around 40%. Risk factors for death commonly identified were increased age, male gender, peripheral vascular disease and renal disease.

AB - A great deal of emphasis, clinical and financial, is placed on limb salvage efforts in diabetic patients suffering from lower extremity ulceration. This is because of the impression that amputation in such patients may be a proximal cause of death. While amputation is certainly a negative clinical outcome, it is not entirely clear that it causes death. In this systematic review, we examine the available literature to attempt to understand the role that the ulceration itself may play in mortality. In brief, we searched for human studies in OVID, CINAHL and the COCHRANE CENTRAL DATABASE from 1980 to 2013, looking for articles related to ulcer or wound of the foot, in patients with diabetes or peripheral vascular disease, and death. We looked for articles with 5years of follow-up, or Kaplan-Meier estimates of 5-year mortality, and excluded reviews and letters. Articles were assessed for quality and potential bias using the Newcastle-Ottawa scale. We find that while the patient populations studied varied widely in terms of demographics and comorbidities, limiting generalisability, 5-year mortality rates after ulceration were around 40%. Risk factors for death commonly identified were increased age, male gender, peripheral vascular disease and renal disease.

KW - Amputation

KW - Diabetes

KW - Mortality

KW - Ulceration

UR - http://www.scopus.com/inward/record.url?scp=84921816455&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921816455&partnerID=8YFLogxK

U2 - 10.1111/iwj.12404

DO - 10.1111/iwj.12404

M3 - Article

C2 - 25601358

AN - SCOPUS:84921816455

JO - International Wound Journal

JF - International Wound Journal

SN - 1742-4801

ER -