PMID- 36332876 OWN - NLM STAT- MEDLINE DCOM- 20230124 LR - 20240130 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 89 DP - 2023 Feb TI - Frailty in People with Chronic Limb Threatening Ischemia and Diabetes-Related Foot Ulcers: A Systematic Review. PG - 322-337 LID - S0890-5096(22)00632-X [pii] LID - 10.1016/j.avsg.2022.09.057 [doi] AB - BACKGROUND: 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 DFUs. The primary outcomes were the impact of frailty on the severity of initial clinical presentation and unfavorable follow-up outcomes including readmissions, major limb amputation, cardiovascular events, revascularization, and wound healing. RESULTS: Ten cohort studies were included. Two studies had a low risk of bias, 1 was unable to be assessed, 5 had moderate risk of bias, and 2 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 ischemia and tissue loss) and poorer outcomes at follow-up (risk of readmission, 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. CI - Copyright (c) 2022 Elsevier Inc. All rights reserved. FAU - Fernando, Malindu E AU - Fernando ME AD - Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; 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. FAU - Blanchette, Virginie AU - Blanchette V AD - Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; Department of Human Kinetics and Podiatric Medicine, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada; VITAM-Centre de recherche en Sante durable, Quebec, Quebec, Canada. FAU - Mishra, Ramkinker AU - Mishra R AD - Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. FAU - Zulbaran-Rojas, Alejandro AU - Zulbaran-Rojas A AD - Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. FAU - Rowe, Vincent AU - Rowe V AD - Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA. FAU - Mills, Joseph L AU - Mills JL AD - Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. FAU - Armstrong, David G AU - Armstrong DG AD - Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA. FAU - Najafi, Bijan AU - Najafi B AD - Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. Electronic address: najafi.bijan@gmail.com. LA - eng GR - R01 DK124789/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Review PT - Systematic Review DEP - 20221102 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Humans MH - Chronic Limb-Threatening Ischemia MH - *Diabetic Foot/diagnosis/epidemiology/surgery MH - *Frailty/complications/diagnosis MH - Treatment Outcome MH - *Peripheral Arterial Disease/diagnosis/surgery MH - Risk Factors MH - Chronic Disease MH - Ischemia/diagnosis/surgery/etiology MH - Limb Salvage/adverse effects MH - Retrospective Studies MH - *Diabetes Mellitus EDAT- 2022/11/05 06:00 MHDA- 2023/01/25 06:00 CRDT- 2022/11/04 20:29 PHST- 2022/08/08 00:00 [received] PHST- 2022/09/13 00:00 [revised] PHST- 2022/09/22 00:00 [accepted] PHST- 2022/11/05 06:00 [pubmed] PHST- 2023/01/25 06:00 [medline] PHST- 2022/11/04 20:29 [entrez] AID - S0890-5096(22)00632-X [pii] AID - 10.1016/j.avsg.2022.09.057 [doi] PST - ppublish SO - Ann Vasc Surg. 2023 Feb;89:322-337. doi: 10.1016/j.avsg.2022.09.057. Epub 2022 Nov 2.