Brian M Schmidt1, James S Wrobel2, Michael Munson2, Gary Rothenberg2, Crystal M Holmes2. 1. University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States. Electronic address: bmcs@med.umich.edu. 2. University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
Abstract
PURPOSE: Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data. METHODS: The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years. RESULTS: We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R2 (without podiatry)=0.45, R2 (with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; p<0.01) and an overall decrease in high-low amputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (p<0.05). CONCLUSIONS: Our findings signify the importance of podiatric care in the diabetic population. With an established podiatry program present at an academic institution, major lower extremity amputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition.
PURPOSE: Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data. METHODS: The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years. RESULTS: We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R2 (without podiatry)=0.45, R2 (with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; p<0.01) and an overall decrease in high-low amputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (p<0.05). CONCLUSIONS: Our findings signify the importance of podiatric care in the diabetic population. With an established podiatry program present at an academic institution, major lower extremity amputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition.
Authors: Sari J Priesand; Brian M Schmidt; Lynn Ang; James S Wrobel; Michael Munson; Wen Ye; Rodica Pop-Busui Journal: J Diabetes Complications Date: 2019-06-20 Impact factor: 2.852
Authors: Brian M Schmidt; Michael E Munson; Gary M Rothenberg; Crystal M Holmes; Rodica Pop-Busui Journal: J Diabetes Complications Date: 2020-07-28 Impact factor: 2.852