Brouwer RJ, Lalieu RC, Hoencamp R, van Hulst RA, Ubbink DT, et al.
Journal of vascular surgery. Date of publication 2020 Feb 1;volume 71(2):682-692.e1.
1. J Vasc Surg. 2020 Feb;71(2):682-692.e1. doi: 10.1016/j.jvs.2019.07.082.
A systematic review and meta-analysis of hyperbaric oxygen therapy for diabetic
foot ulcers with arterial insufficiency.
Brouwer RJ(1), Lalieu RC(2), Hoencamp R(3), van Hulst RA(4), Ubbink DT(5).
Author information:
(1)Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Electronic address: rjbrouwer@alrijne.nl.
(2)Hyperbaar Geneeskundig Centrum, Rijswijk, The Netherlands.
(3)Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands; Defense
Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands;
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
(4)Department of Anesthesiology, Hyperbaric Medicine, Amsterdam University
Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
(5)Department of Surgery, Amsterdam University Medical Centers, University of
Amsterdam, Amsterdam, The Netherlands.
BACKGROUND: Diabetic foot ulcers (DFUs) are frequently associated with peripheral
arterial occlusive disease (PAOD) and may ultimately lead to amputations of the
lower extremity. Adjuvant hyperbaric oxygen treatment (HBOT) might foster better
wound healing and lower amputation rates in patients with DFU and PAOD. A
systematic review was conducted to assess the effects of HBOT as an adjunctive
therapy to standard treatment for patients with DFUs with PAOD.
METHODS: Systematic review using the MEDLINE, EMBASE, and Cochrane CENTRAL
databases (from inception to October 2018). All original, comparative studies on
the effect of HBOT on DFUs with PAOD were eligible. The primary outcome measures
were amputation rate, amputation-free survival, complete ulcer healing, and
mortality.
RESULTS: Eleven studies, totaling 729 patients, were included for analysis,
including 7 randomized clinical trials, 2 controlled clinical trials, and 2
retrospective cohorts. Four were used for quantitative synthesis. Meta-analysis
showed a significantly fewer major amputations in the HBOT group (10.7% vs 26.0%;
risk difference, -15%; 95% confidence interval [CI], -25 to -6; P = .002; number
needed to treat, 7; 95% CI, 4-20). No difference was found for minor amputations
(risk difference, 8%; 95% CI, -13 to 30; P = .46). Three studies reporting on
complete wound healing showed contrasting results. No significant difference was
found for mortality or amputation-free survival.
CONCLUSIONS: Current evidence shows that adjuvant HBOT improves major amputation
rate, but not wound healing, in patients with DFUs and PAOD. Given the wide range
of patients included in the trials, better patient selection may help define
which patients with DFUs and PAOD benefit most from HBOT as standard adjunctive
treatment.
Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1016/j.jvs.2019.07.082
PMID: 32040434 [Indexed for MEDLINE]
