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The Impact of a Podiatric Lead Limb Preservation Team on Disease Outcomes and Risk Prediction in the Diabetic Lower Extremity

A Retrospective Cohort Study

Vickie R. Driver Limb Preservation Service, Department of Vascular Surgery, Madigan Army Medical Center, Tacoma, WA.
Department of Surgery, Boston University School of Medicine and Boston University Medical Center, Boston, MA.

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Russell A. Goodman Department of Biometry, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC.
Biostatistical Consultants Northwest, Seattle, WA.

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Matteo Fabbi Department of Surgery, Boston University School of Medicine and Boston University Medical Center, Boston, MA.

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Michael A. French Department of Surgery, Boston University School of Medicine and Boston University Medical Center, Boston, MA.

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Charles A. Andersen Limb Preservation Service, Department of Vascular Surgery, Madigan Army Medical Center, Tacoma, WA.

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Background: We used a model of lower-extremity ulceration to determine the impact of a podiatric lead limb preservation team on identified relationships among risk factors, predictors of ulceration, amputation, and clinical outcomes of lower-extremity disease in patients with diabetes mellitus.

Methods: A total of 485 patients with diabetes mellitus were randomly selected from the diabetic population and included in this retrospective cohort study. Patients were then stratified into two groups: those who received specialty podiatric medical care and those who did not. Data covering a 5-year period were collected using electronic medical records and chart abstraction to capture detailed treatment characteristics, ulcer status, and surgical outcomes.

Results: Overall, the frequencies of inpatient and outpatient encounters and the durations of hospital stays were significantly greater with increasing wound depth and in the presence of infection. In addition, the overall ulcer incidence was greater in patients with callus (34.3% versus 10.3%, P < .0001) with and without neuropathy (20.4% and 4.1%, P < .0001). Among patients treated in a specialty multidiscipline podiatric medical setting, the proportion of all amputations that were “minor” was significantly increased (33.7% versus 67.3%, P = .0006), and survival was significantly improved (19.5% versus 7.7%, P < .0001).

Conclusions: Early identification of individuals at increased risk for lower-extremity ulceration and subsequent referral for advanced multidiscipline podiatric medical specialty care may decrease rates of ulceration and proximal amputation and improve survival in patients with diabetes mellitus who are at high risk for ulceration and limb loss. (J Am Podiatr Med Assoc 100(4): 235–241, 2010)

Corresponding author: Vickie R. Driver, DPM, MS, Associate Professor of Surgery, Director, Clinical Research, Foot Care, Endovascular, and Vascular Services, Boston University School of Medicine and Boston Medical Center, 732 Harrison, Preston Family Bldg, Boston, MA 02118. (E-mail: vickie.driver@bmc.org)