The Use of Transcutaneous Oximetry to Predict Healing Complications of Lower Limb Amputations: A Systematic Review and Meta-analysis

Arsenault, K.A.; Al-Otaibi, A.; Devereaux, P.J.; Thorlund, K.; Tittley, J.G.; Whitlock, R.P.

doi:10.1016/j.ejvs.2011.12.004

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 43, Issue 3 , Pages 329-336, March 2012

The Use of Transcutaneous Oximetry to Predict Healing Complications of Lower Limb Amputations: A Systematic Review and Meta-analysis

K.A. Arsenault
- Department of Surgery, McMaster University, Hamilton, ON, Canada
A. Al-Otaibi
- Department of Surgery, McMaster University, Hamilton, ON, Canada
P.J. Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
K. Thorlund
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
J.G. Tittley
- Department of Surgery, McMaster University, Hamilton, ON, Canada
R.P. Whitlock
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Corresponding author. R.P. Whitlock, David Braley Cardiac, Vascular and Stroke Research Institute, Room C1-114, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2. Tel.: +1 905 527 4322x40306; fax: +1 905 577 8017.

Received 9 September 2011; accepted 5 December 2011. published online 12 January 2012.

Abstract

Objective

To determine the validity of transcutaneous oximetry (TcPO₂) 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 TcPO₂ 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 TcPO₂ 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 TcPO₂ 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 TcPO₂ 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 TcPO₂ 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.

Keywords: Lower limb amputation, Meta-analysis, Transcutaneous oximetry, Wound healing