Proportionate mortality following dysvascular partial foot amputation and how this compares to transtibial amputation: a systematic review

Figures & data

Table 1. Example search for CINAHL database.

Search	Field code	Search term(s)
1	MH	“Amputation”
2	MH	“Amputees”
3	TI, AB, SU	Amput* AND (Major OR Lowerlimb* OR “Lower limb*” OR “Lower extremit*” OR “Limb loss” OR LEA OR LLA)
4	TI, AB, SU	Amput* AND (Transtibial OR “Trans tibial” OR Belowknee OR Below W2 knee OR “below knee” OR TTA OR BKA)
5	TI, AB, SU	Amput* AND (Minor OR "partial foot" OR Chopart* OR Lisfranc* OR Tarsometatarsal OR Transmetatarsal OR Midtarsal OR "mid tarsal" OR Midfoot OR "mid foot" OR Ray OR Phalangeal OR Metatarsophalangeal OR Toe* OR Transtarsal OR "trans tarsal" OR TMT OR TMA OR MTP OR PFA)
6		1 OR 2 OR 3 OR 4 OR 5
7	TI, AB, SU	(Mortality OR Death OR Survival) AND (Rate* OR Proport* OR Percent*)
8		6 AND 7
9		Limit 8 to English Language
10		Limit 9 to publication date: 1 January 2016 to 12 April 2024
11		Limit 10 to peer-reviewed, academic journals

Field codes: MH exact major and minor subject headings (MeSH, National Library of Medicine Medical Subject Heading), TI title, AB abstract, and SU subject.

Figure 1. PRISMA flowchart.

Table 2. Summary of study designs and outcomes of included studies.

Author	Study design		Outcomes
			Proportionate mortality partial foot amputation					Proportionate mortality transtibial amputation
	Retrospective	Prospective	30 day	1-year	3-years	5-years	Other^a	3day	1-year	3-years	5-years	Other^a
Adams et al. [12]	X		X		X
Gurney et al. [14]	X			X	X		X
Vassallo et al. [44]		X		X			X
Zhang et al. [46]		X		X	X		X
Norvell et al. [53]	X			X					X
Lepow et al. [42]	X			X			X
Chu et al. [45]		X		X	X	X
Faglia et al. [13]	X			X	X		X
Wilbek et al. [47]	X					X
Joyce et al. [15]	X			X	X	X	X
Chung et al. [52]	X			X
López-Valverde et al. [49]	X			X	X	X	X
Blanchette et al. [50]	X			X
Varghese et al. [43]	X			X	X	X	X
Cascini et al. [51]	X			X			X
Birmpili et al. [48]	X			X	X	X
Rolle et al. [11]	X			X

^a Studies that reported proportionate mortality at other time points (e.g., 6-year post-PFA).

Table 3. Summary demographic characteristics of included studies.

Author	Partial foot amputation				Transtibial amputation				Summary of demographic characteristics
	Total no. of PFA (N)	Percent w/diabetes (%)	Sex (% male)	Age (mean ± SD years)	Total no. of TTA (N)	Percent w/diabetes (%)	Sex (% male)	Age (mean ± SD years)	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R
Adams et al. [12]	375	87%	70.90%	66.4 (12.8)					X		X	X	X						X	X	X		X	X
Gurney et al. [14]	1217	100%	68%	65 (13.3)					X	X									X				X	X
Vassallo et al. [44]	81	100%	72%	70 (12.3)							X		X	X			X		X	X
Zhang et al. [46]	97	100%	63.99%	66.5 (9.9)									X	X			X		X	X	X	X	X
Norvell et al. [53]	1504	Not reported for PFA or TTA cohorts. For the total group (PFA, TTA, and TFA), 62% had diabetes.	Not reported for PFA or TTA cohorts. For the total group (PFA, TTA, and TFA), 99.1% were male.	Not reported for PFA or TTA cohorts. For the total group (PFA, TTA, and TFA), mean age was 68 ± 11 years.	3261	Not reported for PFA or TTA cohorts. For the total group (PFA, TTA, and TFA), 62% had diabetes.	Not reported for PFA or TTA cohorts. For the total group (PFA, TTA, and TFA), 99.1% were male.	Not reported for PFA or TTA cohorts. For the total group (PFA, TTA, and TFA), mean age was 68 ± 11 years.	X	X	X	X	X			X		X	X	X		X	X
Lepow et al. [42]	41	75.60%	65.80%	65.6 (11.1)							X		X		X	X			X	X	X		X	X	X
Chu et al. [45]	245	100%	59%	69.27 (9.39)							X	X		X			X		X				X	X		X
Faglia et al. [13]	83	100%	69%	71.4 ± 9.3									X				X		X			X			X	X
Wilbek et al. [47]	777	100%	77%	65.2 (no SD)							X	X	X	X			X		X			X		X		X
Joyce et al. [15]	47	100%	85%	60 (no SD)							X			X					X					X	X
Chung et al. [52]	49	Not reported for the PFA cohort. For the total group, 72% had diabetes.	Not reported for the PFA cohort. For the total group, 57.6% were male.	Not reported for the PFA cohort. For the total group, the mean age was 71.2 (no SD).													X			X				X	X
López-Valverde et al. [49]	116	Not reported for the PFA cohort. For the total group, 83.3% had diabetes.	Not reported for the PFA cohort. For the total group, 78.3% were male.	Not reported for the PFA cohort. For the total group, the median age was 74 (Q1: 64, Q3: 81).							X				X		X	X		X			X	X	X	X
Blanchette et al. [50]	70	100%	85.70%	57.4 (11)					X		X		X			X		X		X	X	X
Varghese et al. [43]	389	78.10%	67.10%	63.3 (14.2)					X		X	X			X		X			X		X		X		X
Cascini et al. [51]	736	100%	73.20%	Mean and SD not reported. Age reported as % age groups 35–54, 55–64, 65–74, and 75+						X								X	X	X				X	X
Birmpili et al. [48]	22 188	83.52%	75.9%	Mean and SD not reported. Age reported in ranges of 40–59, 60–69, 70–79, and >80															X				X			X
Rolle et al. [11]	373	77.6%	67.5%	56.8 (12.1)					X		X				X	X					X		X	X

A: race/ethnicity; B: socio-demographic details (education level, relationship status, employment status, residential status, geographic region, and economic status); C: smoking/tobacco use; D: other lifestyle behaviours (alcohol use, malnutrition, and obesity); E: exams/tests (physical exams, lab tests, and cultures); F: Hb1Ac; G: other biomarkers (GHb, hyperlipidaemia); H: BMI; I: sensation (neuropathy, impaired protective sensation, and vibration perception threshold); J: mental health (major depressive disorders and post-traumatic stress disorder); K: comorbidities (Charlson Comorbidity Index, frequency of comorbidities, Anesthesiology Association of America Physical Status Scale); L: blood pressure/flow issues (missing pulses, Ankle Brachial Index); M: coronary artery disease; N: stroke/CVA; O: other cardiovascular issues (cardiovascular disease, myocardial infarct, heart attack, peripheral arterial disease, peripheral vascular disease, and chronic obstructive pulmonary disease); P: renal issues (nephropathy, renal dialysis, chronic renal failure, renal insufficiency, and end stage renal disease); Q: prior amputation; R: other (immunosuppressant use, joint replacement, Charcot collapse, footwear type, perceived premorbid health, retinopathy, ulcer, and traumatic brain injury).

Figure 2. Proportionate mortality at 1-, 3-, and 5-years after partial foot amputation (random effects meta-analysis).

Table 4. Proportionate mortality reported in different systematic reviews.

	Proportionate mortality following PFA
Systematic reviews	30 days %, (95%CI)	1-year %, (95%CI)	3-years %, (95%CI)	5-years %, (95%CI)
Yammine et al. [56]	3.5 (2.7–4.4)	20.0 (15.2–25.0)	28.0 (24.5–31.6)	44.1 (47.1–47.6)
Dillon et al. [5]	2.8 (2.2–3.6)	17.3 (14.6–20.2)	30.6 (23.0–38.7)	41.2 (32.6–50.1)
This review	2.1 (No CI)	13.9 (11.6–16.3)	30.1 (25.1–35.4)	42.2 (36.0–48.5)

CI: confidence interval.

The 95%CI reported by Yammine et al. [56] have been multiplied by 100 to match the point estimates reported.

Figure 3. Updated proportionate mortality at 1-, 3-, and 5-years after partial foot amputation (random effects meta-analysis) including data from this review and preceding review [5].

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Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.