Congratulations to Crystal Holmes, Jim Wrobel, Gary Rothenberg and Brian Schmidt on this terrific work. It shows, rather clearly, the impact of establishing podiatric care on a health system. In a nutshell: the rate of change from high to low amputations increased by 3 fold over a 16 year period.
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 16 years 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 16 years. 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.