Effect of diabetes on clinical outcomes in patients with peripheral arterial disease undergoing lower extremity revascularization: A systematic review and meta-analysis

Abstract

Background: Peripheral arterial disease is highly prevalent and has a well-established association with diabetes mellitus (DM). However, it remains unclear whether DM worsens clinical outcomes after lower extremity revascularization (LER).

Methods: We performed a systematic search of six databases (Cochrane Library, Embase, Google Scholar, Medline, Scopus, and Web of Science) through February 2024, including studies that reported a risk estimate for the association of DM with 30-day all-cause mortality, hospital readmission, major amputation, and wound infection for patients following LER. For each outcome, a random-effect meta-analysis was applied to pool the relative risk (RR) estimates across studies. I² statistics were used to examine heterogeneity.

Results: Of the 3079 articles screened, 11 observational studies with 139,497 patients were included. A total of 44.8% of patients had DM. DM was associated with an increased risk of 30-day hospital readmission (RR, 1.28; 95% confidence interval (CI), 1.20-1.37; I² = 28%; P < .001), 30-day major limb amputation (RR, 1.31; 95% CI, 1.14-1.50; I² = 86%; P < .001), and 30-day wound infection (RR, 1.32; 95% CI, 1.11-1.56; I² = 81%; P = .001). There was no significant association between DM and 30-day mortality (RR, 1.08; 95% CI, 0.93-1.24; I² = 65%; P = .33).

Conclusions: Our findings suggest that DM is associated with an increased risk of major amputation, readmission, and wound infection risk, but does not affect mortality risk in patients 30 days after LER.

Keywords: Diabetes; Lower extremity revascularization; Major limb amputation; Mortality; Peripheral artery disease; Wound infection.