Frailty in people with chronic limb threatening ischemia and diabetes-related foot ulcers: A systematic review

• Updated on: 2024-02-29
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Frailty in people with chronic limb threatening ischemia and diabetes-related foot ulcers: A systematic review
Malindu E. Fernando
Affiliations
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia
Virginie Blanchette
Affiliations
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
VITAM-Centre de recherche en Santé durable, Québec, QC, Canada
Ramkinker Mishra
Affiliations
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
Alejandro Zulbaran-Rojas
Affiliations
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
Vincent Rowe
Affiliations
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
Joseph L. Mills
Affiliations
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
David G. Armstrong
Affiliations
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
Bijan Najafi
Correspondence
Correspondence author: Professor Bijan Najafi, PhD, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, Phone: (713) 798-7536
Contact
Affiliations
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
Frailty is highly prevalent among people with limb ischaemia and ulceration
•
Frailty may be a surrogate marker of advanced presentation of limb complications
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Frailty may predict unplanned re-admissions, limb-amputation, and death
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Assessment of frailty may aid in decision making regarding surgical interventions
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A major limitation is a current lack of standardized frailty screening
Abstract
Objective
Frailty represents a state of multisystem impairment that may adversely impact people presenting with chronic limb-threatening ischemia (CLTI) and diabetes-related foot ulcers (DFUs). The aim of this systematic review was to explore the association between frailty and outcomes from CLTI and DFUs.
Methods
We performed a systematic literature search of electronic databases to find studies using a validated measure of frailty in individuals with CLTI and/or DFU. The primary outcomes were the impact of frailty on the severity of initial clinical presentation; and unfavorable follow-up outcomes including re-admissions, major limb amputation, cardiovascular events, re-vascularization, and wound healing.
Results
Ten cohort studies were included. Two studies had a low risk of bias, one was unable to be assessed, five had moderate risk of bias and two high-risk of bias. The prevalence of frailty in people presenting with CLTI ranged from 27% to 88% and was 71% in people with DFUs. The presence of frailty in both people with CLTI and DFUs was associated with substantially increased severity at presentation (severity of ischaemia and tissue loss) and poorer outcomes at follow-up (risk of re-admission, limb amputation and all-cause mortality).
Conclusions
The presence of frailty in both people with CLTI and DFUs is likely associated with substantially higher complexity at presentation followed by a greater risk for readmission, amputation, and death during follow-up. Heterogeneity in the tools used to screen for frailty, poor definition of frailty and unclear evaluation of exposure and outcomes limit further interpretation of findings.
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