Debridement of diabetic foot ulcers: public health and clinical implications – a systematic review, meta-analysis, and meta-regression

• Published in: BMJ surgery, interventions, & health technologies interventions, & health technologies, 2022-05, Vol.4 (1), p.e000081
• Main Authors: Dayya, David, O'Neill, Owen, Habib, Nusrat, Moore, Joanna, Iyer, Kartik, Huedo-Medina, Tania B
• Format: Article
• Language: English
• Subjects: Amputation; Bias; Clinical trials; Debridement; Diabetes; Estimates; Foot diseases; Health Care Quality, Access, and Evaluation; Health Services Research; Meta-analysis; Methodology; Methods; Outcome Assessment (Health Care); Outcomes Research; Public health; Review; Staphylococcus infections; Systematic review; Ulcers; Wound healing
• ISSN: 2631-4940; 2631-4940
• DOI: 10.1136/bmjsit-2021-000081

BackgroundDiabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%–34%. Debridement of DFU is regarded as an intervention that accelerates ulcer healing and may reduce complications including amputations, infections, and poor quality of life (QoL), which have serious public health and clinical implications. A systematic review (SR) of SRs and of randomized controlled trials (RCTs) with meta-analyses (MAs) on debridement of DFU that synthesizes all human experimental evidence is warranted.ObjectivesAre debridement methods in DFU beneficial over other forms and standard gauze dressings (control condition) in these outcomes?Study eligibility criteriaAll SRs/MAs/RCTs comparing debridement methods for DFU with alternative methods of debridement and with control.Data sourcesCochrane Wounds Group Specialized Register, Cochrane Central Register of Controlled Trials (Cochrane Library), Ovid MEDLINE, PubMed, EMBASE, EBSCO, CINAHL, and Web of Science.Participants and interventionsAdults with type 1/2 diabetes with DFU and any debridement method compared with alternative debridement methods or control.Main OutcomesAmputation rates, wound infections, QoL, proportion of ulcers healed, time to complete healing, ulcer recurrence, and treatment cost.Study selection and analysisData extraction/synthesis by two independent reviewers pooled using a random-effects model with sensitivity analysis.Results10 SRs were retrieved and reported qualitatively. Six SRs included MAs. This SR included 30 studies, with 2654 participants, using 19 debridement combinations. The debridement methods were compared with findings pooled into MAs. Meta-regression (MR) did not identify significant predictors/moderators of outcomes.LimitationsThe studies may have been under-powered. The inclusion/exclusion criteria varied and the increased risk of bias contributed to low-quality evidence.Discussion/ConclusionWeak evidence exists that debridement methods are superior to other forms of debridement or control in DFU.ImplicationsResearchers should follow standardized reporting guidelines (Consolidated Standards of Reporting Trials). Clinicians/investigators could use the findings from this SR/MA/MR in guiding patient-individualized decision making and designing future RCTs.