Summary:
Abstract
Healthcare institutions with dedicated limb-preservation teams see lower amputation rates and improved quality of care.
This study evaluated the results of a diabetic limb-preservation program implemented at an academic institution.
Patients with diabetes admitted for osteomyelitis below the knee were retrospectively reviewed using ICD-10 codes.
The study analyzed the number and type of amputations, bone biopsies, revascularizations, and the length of hospital stay (LOS).
Outcomes were compared using the high-low (Hi-Lo) amputation ratio for the 24 months before and after the implementation of the limb-preservation service.
In total, 337 patients were included; 140 evaluated in the 24-month period prior to program implementation and 197 afterward.
After the implementation, the overall amputation rate decreased from 67.1% to 59.9%.
Major limb amputation rates decreased significantly from 32.9% to 12.7%.
Conversely, minor amputation rates increased from 34.2% to 47.2%.
The Hi-Lo amputation ratio decreased from 0.96 to 0.27.
The rate of bone biopsies increased from 32.1% to 72.1%.
The rate of revascularization slightly increased from 10.7% to 15.2%.
Average hospital LOS decreased significantly from 11.6 days to 9.8 days.
In conclusion, implementing a limb-preservation team led to a significant drop in major limb amputations, an increase in minor amputations, and a reduction in average hospital LOS.
These results indicate improved clinical care and outcomes for patients with lower extremity osteomyelitis and underline the importance of a diabetic foot-preservation service within healthcare institutions.
Background. Diabetic foot osteomyelitis may precede major limb amputations and lengthy hospital admission. These complications impact patients’ morbidity and mortality. Healthcare institutions with dedicated limb-preservation teams realize reduced amputation rates and improved quality of care. This study evaluates the outcomes following the implementation of a rigorous diabetic limb-preservation program at an academic institution. Methods. Patients with diabetes admitted for osteomyelitis occurring below the knee were identified by ICD-10 codes and included for retrospective review. The number and type of amputations, bone biopsies, revascularizations, and hospital length of stay (LOS) were evaluated. Outcomes were compared using the high-low (Hi-Lo) amputation ratio for the 24 months preceding and the 24 months after the integration of a diabetic limb-preservation service. Results. The authors identified and included 337 patients admitted for diabetic foot osteomyelitis. In the 24-month period prior to program implementation, 140 patients were evaluated. In the 24-month period after program implementation, 197 patients were evaluated. The overall amputation rate decreased from 67.1% (n = 94) to 59.9% (n = 118) (P = .214). Major limb amputation rates significantly decreased from 32.9% (n = 46) to 12.7% (n = 25) (P = .001). Minor amputation rates significantly increased from 34.2% (n = 48) to 47.2% (n = 93) (P = .024). The Hi-Lo amputation ratio decreased from 0.96 to 0.27 (P < .001). The rate of obtaining bone biopsies increased from 32.1% (n = 45) to 72.1% (P < .001). The rate of revascularization increased from 10.7% (n = 15) to 15.2% (n = 30) (P = .299). Average hospital LOS decreased significantly from 11.6 days to 9.8 days (P = .044). Conclusion. After the implementation of a limb-preservation team, there was a precipitous drop in major limb amputations in favor of minor amputations. The average hospital LOS decreased. These findings demonstrated improved clinical care and outcomes in patients with lower extremity osteomyelitis and reinforce the importance of a diabetic foot-preservation service within healthcare institutions.
Keywords: diabetic foot osteomyelitis; limb preservation; lower extremity amputation.
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