Prevalence and risk factors of lower limb amputations in patients with diabetic foot ulcers: A systematic review and meta-analysis

The study aimed at determining prevalence and risk factors (RFs) of diabetic lower limb amputations (LLAs). Electronic databases including PubMed, Medline, Web of Science, and Cochrane Library were searched from January 2003 to April 2021. Sixteen full-text published studies were reviewed. The prevalence of LLAs stood as high as 66%, with a combined prevalence of 19% (95% CI 10–29) using the random-effects model. The most prominent RFs for LLA were duration of diabetes mellitus (DM), age, renal impairment, and ethnic minority. Amongst Australians, Indigenous background is strongly associated with increased risk of the diabetic foot (DF) LLA. LLAs are considerably prevalent amongst patients with the DF and occur at even higher rates in patients with multimorbidity. •We identified a combined prevalence of LLAs among patients with diabetic foot ulcers at 19%.•Risk factors for LLAs include long-duration diabetes, increasing age, and CKD.•Indigenous and ethnic minorities were at a higher risk of diabetic foot ulcers and LLAs.