Economic Value of Podiatric Surgery when Added to A Vascular Surgery Program #ActAgainstAmputation #ToeandFlow @vascularsvs @alpslimb @apma

Important data from Naren Patel et al at the University of Arizona’s Southern Arizona Limb Salvage Alliance (SALSA). Bottom line: With equal number of surgeons, podiatry contributed 40% of total wRVUs generated by the entire program in 2019. Here are the granular data in for those of you interested in developing a limb preservation program.


Over the last decade, multidisciplinary “toe and flow” programs have gained great popularity with proven benefits in limb salvage. Many vascular surgeons have incorporated podiatrists into their practices. The viability of this practice model requires close partnership, hospital support, and financial sustainability. We intend to examine the economic values of podiatrists in a busy safety-net hospital in the Southwest United States.


An administrative database that captured monthly OR cases, clinic encounters, in-patient volume, and total work relative value units (wRVU) in an established limb salvage program in a tertiary referral center were examined. The practice has a diverse patient population with >30% of minority patients. During a period of three years, there was a significant change in the number of podiatrists (n=1 to 4) within the program where the clinical full-time employees for vascular surgeons remained relatively stable.


The limb salvage program experienced >100% of growth in total OR volumes, clinic encounters, and total wRVUs over a period of four years. A total of 35,591 patients were evaluated in a multidisciplinary limb salvage clinic and 5535 procedures were performed. The initial growth of clinic volume and operative volume (P<0.01) were attributed by the addition of vascular surgeons in year one. However, recruitment of podiatrists to the program significantly increased clinic and OR volume by an additional 60% and >40% respectively (P<0.01) in the last three years. With equal number of surgeons, podiatry contributed 40% of total wRVUs generated by the entire program in 2019. Despite that most of the foot and ankle procedures that were regularly performed by vascular surgeons were shifted to the podiatrists, vascular surgeons continued to experience an incremental increase in operative volume and >10% of increase in wRVUs.


This study shows that the value of close collaboration between podiatry and vascular in a limb salvage program extends beyond a patient’s clinical outcome. A financial advantage of including podiatrist in a vascular surgery practice is clearly demonstrated.

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