Post-fasciotomy complications in lower extremity acute compartment syndrome: a systematic review and proportional meta-analysis.

Purpose: This meta-analysis aims to update the evidence on post-fasciotomy outcomes in lower limb acute compartment syndrome (ACS) by quantifying pooled prevalence rates for amputation and mortality and evaluating the impact of key risk factors.

Methods: PRISMA-compliant search of Medline, Embase, CINAHL, and Web of Science was conducted from inception through July 2024. Risk of bias was assessed using the Joanna Briggs Institute and National Institutes of Health tools, with evidence certainty evaluated via the GRADE approach. Prevalence rates with 95% confidence intervals (CI) were calculated using the Freeman-Tukey double arcsine transformation, accounting for between- and within-study variance. Logistic regression models estimated odds ratios (OR) using a random-effects model, with sensitivity analyses excluding low-sample-size studies.

Results: Eleven studies encompassing 2504 patients were included. The pooled prevalence of post-fasciotomy mortality was 7.7% (95% CI, 4.6-11.5%) across eight studies, while amputation prevalence was 10.5% (95% CI, 7.8-13.5%) across 10 studies. Vascular compromise increased amputation odds (OR 1.88, 95% CI 1.03-3.43) but showed no statistically significant association with mortality (OR 2.67, 95% CI 0.77-9.24). Early fasciotomy (< 6 h) reduced amputation odds (OR 0.31, 95% CI 0.13-0.75) and showed a modest trend towards lower mortality. Intracompartmental pressure monitoring (ICPM) was associated with reduced amputation odds (OR 0.23, 95% CI 0.10-0.54), although its effect on mortality was inconclusive.

Conclusion: This meta-analysis demonstrates that early fasciotomy, particularly within six hours, and ICPM may mitigate amputation risk in lower limb ACS. While vascular compromise significantly increases the risk of amputation, its link to mortality remains uncertain. These findings emphasise the importance of timely surgical intervention and suggest potential benefits of ICPM for risk stratification. However, the reliance on observational studies, aggregate data, and retrospective research limits causal inferences. Further high-quality research is needed to validate these associations and inform clinical decision-making.