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Outcomes following major dysvascular lower limb amputation: an updated systematic review
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Political, Historical, Religious and Cultural Studies (from 2013). Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Center for Societal Risk Research, CSR (from 2020).ORCID iD: 0000-0001-8518-1522
University of Toronto, Toronto, Canada : Sunnybrook Health Sciences Centre, Toronto, Canada.
Physical Medicine and Rehabilitation Department, King Fahad Medical City, Riyadh, Saudi Arabia : Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
Physical Medicine and Rehabilitation Department, King Fahad Medical City, Riyadh, Saudi Arabia : Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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2026 (English)In: BMC Cardiovascular Disorders, E-ISSN 1471-2261, Vol. 26, no 1, article id 674Article in journal (Refereed) Published
Abstract [en]

Background Adults with major lower limb amputation (LLA) due to dysvascular etiology often experience diverse health outcomes. However, the absence of standardized outcome reporting limits the ability to synthesize evidence, evaluate care models, and develop consistent clinical pathways. This review updates a systematic review on outcome measures and indicators reported in this population.Methods A systematic review update was conducted across six databases (MEDLINE, EMBASE, EBM Reviews, PsycINFO, Web of Science, and CINAHL) from 20 April 2017 to 1 December 2022. All study designs were eligible; however, the articles needed to report outcome measures and indicators on at least 50% of the adult population with major dysvascular LLAs. The extracted outcome measures and indicators were organized according to Dodd's framework and then reclassified alongside those reported in the study by Ambler and colleagues. The pilot phase of data extraction was carried out independently by multiple reviewers, after which a single reviewer completed the data extraction.Results Of the 12,557 articles, 160 studies reporting data on 228,116 individuals with major dysvascular LLA met the inclusion criteria. Combining these with the 440 studies from the previous review, 2,466 outcome measures and indicators were categorized in five core areas: life impact (25.7%), physiological/clinical (23.4%), death (18.7%), resource use (17.6%), and adverse events (14.6%). In terms of the outcome domains, mortality/survival was the most commonly reported domain, followed by physical functioning (e.g. prosthesis fit, use), skin (e.g., stump wound healing), nervous system outcomes (e.g., residual limb pain), need for further interventions (e.g., prescription of medications), hospital outcomes (e.g., duration of stay, discharge), and adverse events.Conclusion This study builds on a previous review by identifying and categorizing outcome measures and indicators in adults with major dysvascular LLA, highlighting inconsistencies in outcome reporting across studies. The absence of a standardized set of outcome measures and indicators limits the ability to conduct meta-analyses or systematic reviews, evaluate the effectiveness of care models, and establish clinical pathways. Developing a core outcome set tailored to the needs of individuals with dysvascular LLA could help address these challenges by promoting consistency in outcome reporting and enabling meaningful comparisons across studies. Ultimately, this could contribute to improving the quality, efficiency, and person-centeredness of care.Trial registration PROSPERO (CRD42023388570).

Place, publisher, year, edition, pages
Springer Nature, 2026. Vol. 26, no 1, article id 674
Keywords [en]
Amputation, Lower extremity, Outcome assessment, Dysvascular amputation, Systematic review, LOWER-EXTREMITY AMPUTATION, QUALITY-OF-LIFE, BELOW-KNEE AMPUTATION, UNILATERAL TRANSTIBIAL AMPUTATION, PERIPHERAL VASCULAR-DISEASE, MODIFIED FRAILTY INDEX, TOTAL BLOOD-LOSS, RISK-FACTORS, RE-AMPUTATION, DOPPLER ULTRASONOGRAPHY
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Nursing
Research subject
Risk and Environmental Studies
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URN: urn:nbn:se:kau:diva-112085DOI: 10.1186/s12872-026-06377-5ISI: 001842961300001PubMedID: 42568073Scopus ID: 2-s2.0-105046704780OAI: oai:DiVA.org:kau-112085DiVA, id: diva2:2094574
Available from: 2026-08-24 Created: 2026-08-24 Last updated: 2026-08-24Bibliographically approved

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Ghai, Shashank

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