Main risk factors for lower limb amputation in patients with diabetic foot: a systematic review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i8.31599

Keywords:

Amputation; Lower extremity; Diabetic foot.

Abstract

Objective: To analyze the main risk factors for lower limb amputation in patients with diabetic foot. Methodology: This is a systematic review carried out using the PRISMA method, in the electronic databases PubMed, Scopus and Web of Science, using the following descriptors: “limb amputation”, “secondary amputation”, “repeat amputation”, “diabetic foot” and “neuropathy”. Full texts, available in Portuguese, English or Spanish, published between January 2016 and December 2021 were included; studies that focused on factors associated with lower limb amputation in patients with diabetic foot; studies that included diabetic patients over 18 years of age; studies whose factors were listed using statistical data. Results: 12 articles made up the final sample of this study, with a higher frequency of publication in 2021 (n: 04). Most of the studies used the retrospective cohort study, with a moderate level of evidence (III). It was found that the main risk factors statistically associated with the occurrence of lower limb amputation in diabetics were: hypertension (n: 06); peripheral neuropathy (n: 06); chronic kidney disease (n: 05); male sex (n: 05); smoking (n: 05); age over 60 years (n: 04); peripheral vascular disease (n: 04); presence of previous amputation, previous ulcer or foot deformities (n: 04); ulcer size (n: 03); diabetic retinopathy (n: 03). Conclusion: It was found that several factors may be involved in the increase in the prevalence of lower limb amputation in diabetic patients, from sociodemographic issues, lifestyle and factors related to the diabetes clinic itself. Prevention and early intervention actions that consider the reduction of these events are necessary.

Author Biographies

Emanuel de Freitas Correia, Centro Universitário CESMAC

Graduando de Medicina pelo Centro Universitário CESMAC

Wályssa Cheiza Fernandes Santos, Hospital das Clínicas da Universidade Federal de Pernambuco

Enfermeira graduada pela Faculdade de Enfermagem Nossa Senhora das Graças (FENSG - Universidade de Pernambuco), Especialista em Saúde da Mulher pelo Programa de Residência de Enfermagem em Saúde da Mulher no Instituto de Medicina Integral Prof. Fernando Figueira- IMIP e Mestranda em Economia em Saúde pela UFPE. Atualmente com vínculo empregatício com a EBSERH no Hospital das Clínicas de Pernambuco HC/UFPE.

Bianca Priscila Vasconcelos da Cunha, Universidade Católica de Pernambuco

Enfermeira pela Universidade Católica de Pernambuco (UNICAP)

Sabrina Laleska da Silva Souza, Universidade Católica de Pernambuco

Enfermeira pela Universidade Católica de Pernambuco (UNICAP)

Beatriz Rejane da Costa Raposo, Universidade Católica de Pernambuco

Graduanda de Enfermagem pela Universidade Católica de Pernambuco (UNICAP)

Luciana Karla Lima de Queiroz, Centro Universitário Brasileiro

Enfermeira pelo Centro Universitário Brasileiro (UNIBRA)

Jaqueline Maria da Silva, Centro Universitário Brasileiro

Enfermeira pelo Centro Universitário Brasileiro (UNIBRA)

Adrielly de Oliveira Feitosa, Universidade Católica de Pernambuco

Graduanda de Enfermagem pela Universidade Católica de Pernambuco (UNICAP)

Yasmim Lustosa Zaidan, Faculdade Pernambucana de Saúde

Graduanda de Enfermagem pela Faculdade Pernambucana de Saúde (FPS)

José William Araújo do Nascimento, Universidade Federal de Pernambuco

Enfermeiro pela Universidade Católica de Pernambuco (UNICAP), Especialista em Anatomia Humana pela UNINTER e Mestrando em Informática Médica pela Universidade Federal de Pernambuco (Cin-UFPE).

References

Ammar, A. S., Khalid, R., Malik, U., Zeb, M., Abbas, H. M. & Khattak, S. B. (2021). Predictors of lower limb amputations in patients with diabetic foot ulcers presenting to a tertiary care hospital of Pakistan. J Pak Med Assoc. 71(9), 2163-2166.

Arambewela, M. H., Somasundaram, N. P., Jayasekara, H. B. P. R., Kumbukage, M. P., Jayasena, P. M. S., Chandrasekara, C. M. P. H., et al. (2018). Prevalence of chronic complications, their risk factors, and the cardiovascular risk factors among patients with type 2 diabetes attending the diabetic clinic at a tertiary care hospital in Sri Lanka. J Diabetes Res. 2018, 4504287.

Atosona, A. & Larbie, C. (2019). Prevalence and Determinants of Diabetic Foot Ulcers and Lower Extremity Amputations in Three Selected Tertiary Hospitals in Ghana. J Diabetes Res. 2019, 7132861.

Aumiller, W. D. & Dollahite, H. A. (2015). Pathogenesis and management of diabetic foot ulcers. JAAPA. 28(5), 28-34.

Brasil. Ministério da Saúde (MS). (1998). Lei no 9.610, de 19 de fevereiro de 1998, que altera, atualiza e consolida a legislação sobre direitos autorais e dá outras providências. Diário Oficial da União. Brasília: Ministério da Saúde. Recuperado de http://www.planalto.gov.br/ccivil_03/leis/l9610.htm

Brasil. Ministério da Saúde (MS). (2016). Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília: Ministério da Saúde.

Recuperado de http://www.as.saude.ms.gov.br/wp-content/uploads/2016/06/manual_do_pe_diabetico.pdf

Chaudhary, N., Huda, F., Roshan, R., Basu, S., Rajput, D. & Singh, S. K. (2021). Lower Limb Amputation Rates in Patients With Diabetes and an Infected Foot Ulcer: A Prospective Observational Study. Wound Manag Prev. 67(7), 22-30.

Dunbar, G. L., Hellenberg, D. A. & Levitt, N. S. (2015). Diabetes mellitus and non-traumatic lower extremity amputations in four public sector hospitals in Cape Town, South Africa, during 2009 and 2010. SAMJ, S. African Medical Journal. 105, 1053–1056.

Gurney, J. K., Stanley, J., Rumball-Smith, J., York, S. & Sarfati, D. (2018). Postoperative death after lower-limb amputation in a national prevalent cohort of patients with diabetes. Diabetes Care. 41(6), 1204–1211.

Hallström, S., Svensson, A. M., Pivodic, A., Ólafsdóttir, A. F., Londahl, M., Wedel, H., et al. (2021). Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry. Diabetologia. 64(12), 2751-2761.

International Diabetes Federation (IDF). (2019). IDF Diabetes Atlas. Ninth edition. Bruselas, Bélgica: IDF. https://www.diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf

International Standards Organization (ISO). (2014). Prosthetics and orthotics - Vocabulary. Part 4: Terms relating to limb amputation. 8549-8554. https://www.iso.org/obp/ui/#iso:std:iso:8549:-4:ed-1:v1:en

Jeffcoate, W. J., Vileikyte, L., Boyko, E. J., Armstrong, D. G. & Boulton, A. J. M. (2018). Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes Care. 41, 645-652.

Kaneko, M., Fujihara, K., Harada, M. Y., Osawa, T., Yamamoto, M., Kitazawa, M., et al. (2021). Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database. J Foot Ankle Res. 14(1), 29.

Keogh, E. (2015). Men, masculinity, and pain. Pain. 156(12), 2408–2412.

Kolossváry, E., Farkas, K., Colgan, M. P., Edmonds, M., Fitzgerald, H. P., Fox, M., et al. (2017). “No more amputations”: a complex scientific problem and a challenge for effective preventive strategy implementation on vascular field. Int Angiol. 36(2), 107–115.

Lazzarini, P. A., Hurn, S. E., Kuys, S. S., Kamp, M. C., Ng, V., Thomas, C., et al. (2017). Foot complications in a representative Australian inpatient population. J Diabetes Res, 2017.

Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., et al. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 10(1), 14790.

Liu, M., Zhang, W., Yan, Z. & Yuan, X. (2018). Smoking increases the risk of diabetic foot amputation: A meta-analysis. Exp Ther Med. 15(2). 1680–1685.

Malyar, N.M., Freisinger, E., Meyborg, M., Lueders, F., Gebauer, K., Reinecke, H., et al. (2016). Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome. J Diabetes Complicat. 30(6), 1117-1122.

Mantovani, A. M., Fregonesi, C. E. P. T., Palma, M. R., Ribeiro, F. E., Fernandes, R. A. & Christofaro, D. G. D. (2016). Relationship between amputation and risk factors in individuals with diabetes mellitus: a study with Brazilian patients. Diabetes & Metabolic Syndrome-Clinical Research & Reviews. 11(1), 47-50.

Margolis, D. J., Gupta, J., Thom, S. R., Townsend, R. R., Kanetsky, P. A., Hoffstad, O., et al. (2013). Diabetes, lower extremity amputation, loss of protective sensation, and neuronal nitric oxide synthase associated protein in the Chronic Renal Insufficiency Cohort study. Wound Repair Regener. 21, 17-24

Mishra, S. C., Chhatbar, K. C., Kashikar, A. & Mehndiratta, A. (2017). Diabetic foot. BMJ. 359.

Mtshali, S. & Mahomed, O. (2020). Patient-level predictors of diabetes-related lower extremity amputations at a quaternary hospital in South Africa. PLoS One. 15(10), e0240588.

Nascimento, J. W. A., Jesus, S. B., Silva, E. C. S., Ferreira Júnior, M. L. & Miranda, A. P. (2019). Neuropatia do pé diabético em usuários de uma unidade de saúde da família. Rev Nursing, 22(256), 3165-3168.

Nascimento, J. W. A., Silva, E. C. S., Ferreira Junior, M. L. & Jesus, S. B. (2019). Construção e validação de um manual de detecção do pé diabético para atenção primária. Enferm. Foco. 10(6), 85-91.

Nascimento, J. W. A., Silva, E. C. S., Roque, G. S. L., Ferreira Júnior, M. L. & Jesus, S. B. (2020). Correlation between the type of footwear with physical

changes in diabetic. Rev Enferm UFPI. 9, e10189.

Nascimento, J. W. A., Santos, R. S., Santos, T. M. R., Silva, A. L. B., Rodrigues, L. D. C., Silva, V. W., et al. (2021). Complications associated with intimate partner violence in pregnant women: a systematic review. Int. J. Dev. Res. 11(7), 48924-48928.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et. al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 372:n71.

Pati, D. & Lorusso, L. N. (2018). How to Write a Systematic Review of the Literature. HERD. 11(1), 15-30.

Rodrigues, B. T., Vangaveti, V. N. & Malabu, U. H. (2016). Prevalence and risk factors for diabetic lower limb amputation: a clinic-based case control study. J Diabetes Res. 2016, 5941957.

Sahu, A., Sagar, R., Sarkar, S. & Sagar, S. (2016). Psychological effects of amputation: a review of studies from India. Industrial Psychiatry Journal. 25(1), 4–10.

Santos, I. C. R. V., Carvalho, E. F., Souza, W. V. & Albuquerque, E. C. (2015). Factors associated with diabetic foot amputations. Jornal Vascular Brasileiro. 14(1), 37–45.

Shabani Varaki, E., Gargiulo, G. D., Penkala, S. & Breen, P. P. (2018). Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed Eng Online. 17, 61.

Shatnawi, N. J., Al-Zoubi, N. A., Hawamdeh, H. M., Khader, Y. S., Garaibeh, K. & Heis, H. A. (2018). Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Diabetes, Metab Syndrome Obes Targets Ther. 11, 313-319.

Stillwell, S., Fineout-Overholt, E., Melnyk, B. M. & Wiliamson, K. M. (2010). Evidence– based practice: step by step. Am J Nurs; 110(5), 41-47.

Syafril, S. (2018). Pathophysiology diabetic foot ulcer. IOP Conf. Ser.: Earth Environ. Sci. 125, 012161.

Xia, N., Morteza, A., Yang, F., Cao, H. & Wang, A. (2019). Review of the role of cigarette smoking in diabetic foot. Journal of Diabetes Investigation. 10(2), 202-215.

Zhang, Y., Lazzarini, P. A., McPhail, S. M., van Netten, J. J., Armstrong, D. G. & Pacella, R. E. (2020). Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care. 43(5), 964–974.

Published

30/06/2022

How to Cite

CORREIA, E. de F.; SANTOS, W. C. F.; CUNHA, B. P. V. da .; SOUZA, S. L. da S.; RAPOSO, B. R. da C.; QUEIROZ, L. K. L. de .; SILVA, J. M. da .; FEITOSA, A. de O.; ZAIDAN, Y. L.; NASCIMENTO, J. W. A. do . Main risk factors for lower limb amputation in patients with diabetic foot: a systematic review. Research, Society and Development, [S. l.], v. 11, n. 8, p. e59511831599, 2022. DOI: 10.33448/rsd-v11i8.31599. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/31599. Acesso em: 25 apr. 2024.

Issue

Section

Health Sciences