The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot

David G Armstrong, Manish Bharara, Matthew White, Brian Lepow, Sugam Bhatnagar, Timothy Fisher, Heather R. Kimbriel, Jodi Walters, Kaoru R. Goshima, John D Hughes, Joseph L Mills

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Objective: This study aimed 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 24months 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, 95% CI: 2.0-83.3). A 45.7% reduction in below-knee amputations was realized with a stable above-knee/below-knee amputation ratio (0.73-0.81). 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 and preventive, rather than reactive and ablative, procedures. Although endovascular limb-sparing procedures have become increasingly applicable, open bypass remains critical to success.

Original languageEnglish (US)
Pages (from-to)514-518
Number of pages5
JournalDiabetes/Metabolism Research and Reviews
Volume28
Issue number6
DOIs
StatePublished - Sep 2012

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Diabetic Foot
Blood Vessels
Amputation
Knee
Diabetes Complications
Limb Salvage
Registries
Extremities

Keywords

  • Amputation
  • Diabetic foot
  • Limb salvage
  • Revascularization
  • Wound healing

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot. / Armstrong, David G; Bharara, Manish; White, Matthew; Lepow, Brian; Bhatnagar, Sugam; Fisher, Timothy; Kimbriel, Heather R.; Walters, Jodi; Goshima, Kaoru R.; Hughes, John D; Mills, Joseph L.

In: Diabetes/Metabolism Research and Reviews, Vol. 28, No. 6, 09.2012, p. 514-518.

Research output: Contribution to journalArticle

Armstrong, David G ; Bharara, Manish ; White, Matthew ; Lepow, Brian ; Bhatnagar, Sugam ; Fisher, Timothy ; Kimbriel, Heather R. ; Walters, Jodi ; Goshima, Kaoru R. ; Hughes, John D ; Mills, Joseph L. / The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot. In: Diabetes/Metabolism Research and Reviews. 2012 ; Vol. 28, No. 6. pp. 514-518.
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abstract = "Objective: This study aimed 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 24months 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, 95{\%} CI: 2.0-83.3). A 45.7{\%} reduction in below-knee amputations was realized with a stable above-knee/below-knee amputation ratio (0.73-0.81). 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 and preventive, rather than reactive and ablative, procedures. Although endovascular limb-sparing procedures have become increasingly applicable, open bypass remains critical to success.",
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AU - Bhatnagar, Sugam

AU - Fisher, Timothy

AU - Kimbriel, Heather R.

AU - Walters, Jodi

AU - Goshima, Kaoru R.

AU - Hughes, John D

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