• 1

    Ramsey SD, Newton K, Blough D, et al: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. .Diabetes Care 22::382. ,1999. .

  • 2

    Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. .JAMA 293::217. ,2005. .

  • 3

    Markowitz JS, Gutterman EM, Magee G, et al: Risk of amputation in patients with diabetic foot ulcers: a claims-based study. .Wound Repair Regen 14::11. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Centers for Disease Control and Prevention: National diabetes fact sheet, 2003. Available at: http://www.cdc.gov/diabetes/pubs/factsheet.htm. Accessed March 31. ,2006. .

  • 5

    Sandnes DK, Sobel M, Flum DR: Survival after lower-extremity amputation. .J Am Coll Surg 199::394. ,2004. .

  • 6

    Mayfield JA, Reiber GE, Maynard C, et al: Survival following lower-limb amputation in a veteran population. .J Rehabil Res Dev 38::341. ,2001. .

  • 7

    Tentolouris N, Al-Sabbagh S, Walker MG, et al: Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. .Diabetes Care 27::1598. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Faglia E, Favales F, Morabito A: New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993: a 6.5-year follow-up. .Diabetes Care 24::78. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Aulivola B, Hile CN, Hamdan AD, et al: Major lower extremity amputation: outcome of a modern series. .Arch Surg 139::395. ,2004. .

  • 10

    Peters EJ, Childs MR, Wunderlich RP, et al: Functional status of persons with diabetes-related lower-extremity amputations. .Diabetes Care 24::1799. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Coffey JT, Brandle M, Zhou H, et al: Valuing health-related quality of life in diabetes. .Diabetes Care 25::2238. ,2002. .

  • 12

    Ollendorf DA, Kotsanos JG, Wishner WJ, et al: Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. .Diabetes Care 21::1240. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    American Diabetes Association: Consensus Development Conference on Diabetic Foot Wound Care: 7–8 April 1999, Boston, Massachusetts. .Diabetes Care 22::1354. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Larsson J, Agardh CD, Apelqvist J, et al: Long-term prognosis after healed amputation in patients with diabetes. .Clin Orthop Relat Res 350::149. ,1998. .

    • Search Google Scholar
    • Export Citation
  • 15

    Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .

  • 16

    Moss SE, Klein R, Klein BE: The 14-year incidence of lower-extremity amputations in a diabetic population: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. .Diabetes Care 22::951. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Reiber GE, Boyko EJ, Smith DG: “Lower Extremity Foot Ulcers and Amputations in Diabetes,” in Diabetes in America, 2nd Ed, ed by National Diabetes Data Group, p 409, National Institutes of Health, Bethesda, MD. ,1995. .

  • 18

    Steed DL, Donohoe D, Webster MW, et al: Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. .J Am Coll Surg 183::61. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Gentzkow GD, Iwasaki SD, Hershon KS, et al: Use of Dermagraft, a cultured human dermis, to treat diabetic foot ulcers. .Diabetes Care 19::350. ,1996. .

  • 20

    Moulik PK, Mtonga R, Gill GV: Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. .Diabetes Care 26::491. ,2003. .

  • 21

    Muller IS, de Grauw WJ, van Gerwen WH, et al: Foot ulceration and lower limb amputation in type 2 diabetic patients in Dutch primary health care. .Diabetes Care 25::570. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Andros G, Armstrong DG, Attinger C, et al: Consensus statement on negative pressure wound therapy (V.A.C.® Therapy) for the management of diabetic foot wounds. .Ostomy Wound Manage 52: (suppl):1. ,2006. .

    • Search Google Scholar
    • Export Citation
  • 23

    Saxena V, Hwang CW, Huang S, et al: Vacuum-assisted closure: microdeformations of wounds and cell proliferation. .Plast Reconstr Surg 114::1086. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Armstrong DG, Lavery LA: Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. .Lancet 366::1704. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Clare MP, Fitzgibbons TC, McMullen ST, et al: Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. .Foot Ankle Int 23::896. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Page JC, Newswander B, Schwenke DC, et al: Retrospective analysis of negative pressure wound therapy in open foot wounds with significant soft tissue defects. .Adv Skin Wound Care 17::354. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Armstrong DG, Lavery LA, Abu-Rumman P, et al: Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. .Ostomy Wound Manage 48::64. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Philbeck TE, Schroeder WJ, Whittington KT: Vacuum-assisted closure therapy for diabetic foot ulcers: clinical and cost analysis. .Home Care Consultant 8::27. ,2001. .

    • Search Google Scholar
    • Export Citation
  • 29

    Eginton MT, Brown KR, Seabrook GR, et al: A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. .Ann Vasc Surg 17::645. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    McCallon SK, Knight CA, Valiulus JP, et al: Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. .Ostomy Wound Manage 46::28. ,2000. .

    • Search Google Scholar
    • Export Citation
  • 31

    Hogan P, Dall T, Nikolov P: Economic costs of diabetes in the US in 2002. .Diabetes Care 26::917. ,2003. .

  • 32

    Palmetto DMERC Policy on NPWT: Negative pressure wound therapy pumps. Available at: http://www.palmettogba.com. Accessed May 28. ,2006. .

  • 33

    Wagner FW Jr: The dysvascular foot: a system for diagnosis and treatment. .Foot Ankle 2::64. ,1981. .

  • 34

    Zar JH: Biostatistical Analysis, 4th Ed, Prentice Hall, Upper Saddle River, NJ. ,1999. .

  • 35

    Ortegon MM, Redekop WK, Niessen LW: Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. .Diabetes Care 27::901. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    International Diabetes Federation Web site. Available at: http://www.idf.org/home. Accessed March 20. ,2006. .

  • 37

    Gluck ME, Hanson KW: Medicare Chart Book, Henry J. Kaiser Family Foundation, Menlo Park, CA. ,2001. .

  • 38

    Dulworth S, Pyenson B: Healthcare-associated infections and length of hospital stay in the Medicare population. .Am J Med Qual 19::121. ,2004. .

  • 39

    Pyenson B, Connor S, Fitch K, et al: Medicare cost in matched hospice and non-hospice cohorts. .J Pain Symptom Manage 28::200. ,2004. .

  • 40

    Margolis DJ, Kantor J, Santanna J, et al: Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. .Arch Dermatol 136::1531. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Kinetic Concepts Inc: V.A.C.® NPWT device, data on file, KCI, San Antonio, TX. ,2005. .

Negative-Pressure Wound Therapy and Diabetic Foot Amputations

A Retrospective Study of Payer Claims Data

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  • 1 Podiatry Section, Carl T. Hayden Veterans Administration Medical Center, Phoenix, AZ.
  • | 2 Milliman Inc, Windsor, CT.
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Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers.

Methods: Administrative claims data for patients with diabetic foot ulcers from commercial payers (n = 3,524) and Medicare (n = 12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes. Risk-adjustment procedures were then performed to match patient risk categories (through total treatment costs) and wound severities (through debridement depth).

Results: The incidence of amputations in the NPWT groups was lower than that in the control groups. For the cost-based risk-adjustment analysis, amputation incidences with NPWT versus traditional therapy were 35% lower in the Medicare sample (10.8% versus 16.6%; P = .0077) and 34% lower in the commercial payer sample (14.1% versus 21.4%; P = .0951). Whereas overall amputation rates increased progressively with increasing wound debridement depth in both control groups, the same increasing trend did not occur in the NPWT groups.

Conclusions: Patients with diabetic foot ulcers in the Medicare sample treated with NPWT had a lower incidence of amputations than those undergoing traditional wound therapy; this finding was evident in wounds of varying depth in both populations studied. (J Am Podiatr Med Assoc 97(5): 351–359, 2007)

Corresponding author: Robert G. Frykberg, DPM, MPH, Podiatry Section, Carl T. Hayden Veterans Administration Medical Center, 650 E Indian School Rd, Phoenix, AZ 85012.