The incidence of surgical site infection following major lower limb amputation: A systematic review

Abstract

Surgical site infections (SSIs) following major lower limb amputation (MLLA) in vascular patients are a major source of morbidity. The objective of this systematic review was to determine the incidence of SSI following MLLA in vascular patients. This review was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023460645). Databases were searched without date restriction using a pre-defined search strategy. The search identified 1427 articles. Four RCTs and 21 observational studies, reporting on 50 370 MLLAs, were included. Overall SSI incidence per MLLA incision was 7.2% (3628/50370). The incidence of SSI in patients undergoing through-knee amputation (12.9%) and below-knee amputation (7.5%) was higher than the incidence of SSI in patients undergoing above-knee amputation, (3.9%), p < 0.001. The incidence of SSI in studies focusing on patients with peripheral arterial disease (PAD), diabetes or including patients with both was 8.9%, 6.8% and 7.2%, respectively. SSI is a common complication following MLLA in vascular patients. There is a higher incidence of SSI associated with more distal amputation levels. The reported SSI incidence is similar between patients with underlying PAD and diabetes. Further studies are needed to understand the exact incidence of SSI in vascular patients and the factors which influence this.

Keywords: amputation; diabetes; lower limb; peripheral arterial disease; surgical site infection.

FIGURE 1

PRISMA flow diagram of literature search of randomised controlled trials and observational studies reporting incidence of SSI in patients who had major lower limb amputations performed secondary to peripheral arterial disease and/or diabetic foot infection. MLLA, major lower limb amputation; PAD, peripheral arterial disease; SSI, surgical site infection.

FIGURE 2

Graph illustrating the incidence of SSI (%) in each of the studies, including the intervention and control arms of the RCTs.

FIGURE 3

Bubble plot of the incidence of SSI (%) by year of study publication. The line of best fit shows the incidence of SSI per MLLA reduces with year of publication, and the area of the circle is proportionate to the number of patients in each study.