AIMS To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes. METHODS A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. RESULTS Twenty studies met the inclusion criteria. Nine studies were included in the meta-analysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis. CONCLUSIONS Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on "possible limbs saved". FUNDING None.

中文翻译：

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多学科护理团队在降低成人糖尿病患者大截肢率方面的有效性：系统评价和荟萃分析。

目的确定多学科护理团队（MCT）在降低成年人糖尿病患者的主要截肢率方面的综合效力。方法进行了系统的回顾和荟萃分析，搜索了数据库MEDLINE，EMBASE，Google Scholar，Cochrane图书馆和Clinicaltrials.gov直至2018年10月。我们仅进行了前后比较研究，比较了实施MCT手术前后截肢率预防成人糖尿病患者的大截肢。我们的主要结局是截肢的相对风险。使用固定效应模型计算风险比和95％置信区间。结果二十项研究符合纳入标准。荟萃分析包括九项研究，定性分析包括十一项研究。暴露于MCT导致的保护作用范围从RR的0.44 [p值<0.00001（95％CI 0.38，0.51）I2 = 67％]到RR的0.61 [p值<0.0001，（95％CI 0.50，0.75）I2 = 0％]，并在定性分析中保持稳健。结论实施MCT截肢预防计划后，医疗保健系统可以预期将截肢率降低39-56％。这些发现可以通过帮助医疗保健系统预测这些团队在“可能的四肢节省”方面的预期收益，来证明计划实施所需的其他资源的使用是合理的。资金无。结论实施MCT截肢预防计划后，医疗保健系统可以预期将截肢率降低39-56％。这些发现可以通过帮助医疗保健系统预测这些团队在“可能的四肢节省”方面的预期收益，来证明计划实施所需的其他资源的使用是合理的。资金无。结论实施MCT截肢预防计划后，医疗保健系统可以预期将截肢率降低39-56％。这些发现可以通过帮助医疗保健系统预测这些团队在“可能的四肢节省”方面的预期收益，来证明计划实施所需的其他资源的使用是合理的。资金无。