Factors Influencing Major Amputation and Death Following Diabetic Limb Salvage
Summary: This systematic review of 49 studies (2020–2025) and real-world analysis of 72 high-risk diabetic patients via the Mid Essex Diabetes Amputation Reduction Plan (MEDARP) identifies key predictors of major amputation and mortality after limb salvage surgery for diabetic foot ulcers. Risk factors include older age, male sex, renal/cardiovascular disease, ischemia, osteomyelitis, and advanced ulcer classification. MDT models consistently lowered amputation rates (e.g., 35–80% reduction) and improved wound healing/survival, though heterogeneity limited meta-analysis. MEDARP achieved 6.9% major amputation and 12.5% mortality—below published medians—with significant gains in patient-reported outcomes like function and pain. Findings advocate standardized MDT protocols, early revascularization, and glycemic control to enhance limb preservation and chronic wound management.
Key Highlights:
- Risk factors: Demographic (age, sex, race), clinical (CKD, PAD, ESRD, high HbA1c, low albumin, elevated CRP), surgical (wound size, infection, revascularization failure) predict 0–67.7% amputation and 9–18% 1-year mortality.
- MDT benefits: Reduced amputations (e.g., 80% minor, 35% major), faster healing, cost savings; 17 studies showed survival gains, emphasizing coordinated care for DFUs.
- MEDARP outcomes: 6.9% major amputation, 12.5% mortality in 72 patients; MSK-HQ scores rose from 29.3 to 49.4, MOXFQ pain/social scores improved markedly over 11 months.
- Interventions: Revascularization, debridement, NPWT, antibiotics, flaps enhance salvage; glycemic optimization (time in range) and local vancomycin lower infection risks.
- Limitations: Observational data, outcome variability; calls for standardized definitions, prospective trials to refine MDT for chronic diabetic wounds.
Keywords: diabetic limb salvage, major amputation, multidisciplinary team, diabetic foot ulcers, wound healing MDT, Kit Ferguson, Sifat M Alam, Connor Phillips