Arsenault KA, Al-Otaibi A, Devereaux PJ, Thorlund K, Tittley JG, Whitlock RP, et al.
European journal of vascular and endovascular surgery : the official journal of the European So.... Date of publication 2012 Mar 1;volume 43(3):329-36.
1. Eur J Vasc Endovasc Surg. 2012 Mar;43(3):329-36. doi: 10.1016/j.ejvs.2011.12.004.
Epub 2012 Jan 10.
The use of transcutaneous oximetry to predict healing complications of lower limb
amputations: a systematic review and meta-analysis.
Arsenault KA(1), Al-Otaibi A, Devereaux PJ, Thorlund K, Tittley JG, Whitlock RP.
Author information:
(1)Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
OBJECTIVE: To determine the validity of transcutaneous oximetry (TcPO(2)) as a
predictor of lower limb amputation healing complications.
DESIGN: A systematic review and meta-analysis.
METHODS: We searched five major medical databases, relevant review articles and
reference lists and included all studies that evaluated TcPO(2) for its ability
to predict lower limb amputation healing failure. We selected eligible articles
and conducted data abstraction independently and in duplicate.
RESULTS: Thirty-one studies, enrolling 1824 patients with 1960 amputations, met
our inclusion criteria. Only one study reported undertaking a multivariable
analysis, which demonstrated that a TcPO(2) level below 20 mmHg was an
independent predictor of re-amputation occurrence (adjusted odds ratio (OR) 3.08,
95% confidence interval (CI) 1.19-7.98). Fourteen prospective cohort studies
reported data that allowed for the calculation of an unadjusted relative risk of
lower limb amputation healing complications leading to amputation revision
associated with a TcPO(2) level below cut-offs of 10 mmHg (1.80; 95% CI
1.19-2.72), 20 mmHg (1.75; 95% CI 1.27-2.40) 30 mmHg (1.41; 95% CI 1.22-1.62) and
40 mmHg (1.24; 95% CI 1.13-1.39).
CONCLUSIONS: This review suggests that TcPO(2) predicts healing complications of
lower limb amputations. A value of less than 40 mmHg results in a 24% increased
risk of healing complication compared to over 40 mmHg and the risk further
increases as the TcPO(2) decreases. There is, however, insufficient evidence to
judge whether this tool adds important information beyond clinical data or to
suggest an optimal threshold value. There is a need for a large, sufficiently
powered study that adjusts for appropriate clinical variables.
Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier
Ltd. All rights reserved.
DOI: 10.1016/j.ejvs.2011.12.004
PMID: 22240334 [Indexed for MEDLINE]
