A Systematic Review and Meta-Analysis of the Incidence and Risk Factors for Re-admission to Hospital in People with Diabetes Related Foot Disease

Objective: The aim of this study was to systematically review the incidence and risk factors for 30 day readmission to hospital following an index admission to treat diabetes related foot disease (DFD).Data sources: A literature search was conducted using Medline/PubMed, Scopus, Cochrane Library, and CINAHL databases.Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Studies that reported the rate of total or DFD related 30 day re-admissions were included. Meta-analysis was performed using a random effects model to calculate the pooled mean (95% confidence interval [CI]) of the proportion of patients re-admitted to hospital within 30 days. Meta-regression was performed to determine the association between risk factors and 30 day re-admission.Results: Sixteen retrospective studies with a total of 124 683 participants were included. The mean total 30 day readmission rate was 22.0% (95% CI 17.0 27.0%) while the mean DFD related 30 day re-admission rate was 10.0% (95% CI 7.0 15.0%). Meta-regression found that greater prevalence of peripheral neuropathy (p = .045) was associated with a higher rate of any 30 day re-admission, and male sex (p = .023) and private health insurance (p = .048) were associated with lower rates of any 30 day re-admission. Coronary artery disease (p= .025) was associated with a higher rate of DFD related re-admission. All studies had low or moderate risk of bias.Conclusion: This systematic review suggested that about one fifth of patients with DFD are re-admitted to hospital within 30 days, of which about half are to treat DFD. Risk factors for re-admission included female gender, peripheral neuropathy, lack of private health insurance, and coronary artery disease.