Document Detail


The Impact and Outcomes of Establishing an Integrated Interdisciplinary Surgical Team To Care for The Diabetic Foot.
MedLine Citation:
PMID:  22431496     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To quantify the impact of an integrated diabetic foot surgical service on outcomes and changes in surgical volume and focus. METHODS: We abstracted registry data from 48 consecutive months at a single institution, evaluating all patients with diabetic foot complications requiring surgery or vascular intervention and compared outcomes in the 24 months before and after integrating podiatric surgery with vascular surgical limb-salvage service. RESULTS: The service performed 2923 operations; 790 (27.0%) were related to treatment of diabetic foot complications in 374 patients. Of these, 502 were classified as non-vascular diabetic foot surgery and 288 were vascular interventions. Urgent surgery was significantly reduced after team implementation (77.7% vs. 48.5% p <0.0001, OR = 3.7, 95% CI: 2.4 - 5.5). The high/low amputation ratio decreased from 0.35 to 0.27 due to an increase in low-level (midfoot) amputations (8.2% vs. 26.1%, p <0.0001, OR = 4.0, CI: 2.0 to 83.3) A 45.7% reduction in BKAs was realized with a stable above knee/below knee amputation (AKA/BKA) ratio (0.73 to 0.81). One-third of patients required vascular intervention. Vascular reconstructions increased 44.1% following institution of the team. Initial revascularization was endovascular in 70.6% of patients. Repeat endovascular intervention or conversion to open bypass was required in 37.1% of these patients, almost double the reintervention rate of those receiving open bypass first (18.9%). CONCLUSIONS: Interdisciplinary diabetic foot surgery teams may significantly impact surgery type, with greater focus on proactive/preventive rather than reactive/ablative procedures. While endovascular limb-sparing procedures have become increasingly applicable, open bypass remains critical to success. Copyright © 2012 John Wiley & Sons, Ltd.
Authors:
David G Armstrong; Manish Bharara; Matthew White; Brian Lepow; Sugam Bhatnagar; Timothy Fisher; Heather R Kimbriel; Jodi Walters; Kaoru R Goshima; John Hughes; Joseph L Mills
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-19
Journal Detail:
Title:  Diabetes/metabolism research and reviews     Volume:  -     ISSN:  1520-7560     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883450     Medline TA:  Diabetes Metab Res Rev     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 John Wiley & Sons, Ltd.
Affiliation:
University of Arizona, Surgery, 1501 N Campbell Ave. Southern Arizona Limb Salvage Alliance, Tucson, Arizona, 85724, United States. armstrong@usa.net.
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