A new national study published in JAMA Network Open offers a hopeful message for clinicians and care teams: where and how patients with diabetic foot ulcers (DFUs) are treated makes a measurable difference in whether they keep their limbs .
Researchers led by Hiroyuki Suzuki, MD, MSCI, and including our long-time friend and colleague Prof. Jeff Robbins, VACO Podiatry Chief, analyzed outcomes from 86,094 veterans newly diagnosed with DFUs across 140 Veterans Health Administration (VHA) facilities between 2016 and 2021. They found that major leg amputation rates varied widely between facilities—even after accounting for patient demographics, comorbidities, and social factors . For an average patient, the odds of undergoing a major amputation were nearly twofold higher depending solely on where they were treated (Median Odds Ratio = 1.85) .
Why This Matters:
Unlike immutable factors like age or underlying disease severity, clinic-level practices are modifiable.
Facilities with strong limb preservation protocols—timely wound care, multidisciplinary collaboration, aggressive vascular management—achieved markedly better outcomes .
While social determinants of health still play a role, this study shows that individual clinicians and care teams can significantly bend the curve toward limb salvage through better coordination, earlier interventions, and dedicated attention to DFU management.
Key Findings:
- Complicated ulcers (with infection or gangrene) and comorbidities like peripheral vascular disease were major risk factors .
- Race and ethnicity were independently associated with higher amputation risk, underscoring persistent disparities .
- Yet, facility-level care differences had an even greater influence on outcomes than many patient-level characteristics .
The Bigger Picture:
In contrast to major amputation, 1-year mortality varied much less across facilities, suggesting that variation in limb loss is not inevitable—it reflects the quality of diabetic foot care .
The findings support national efforts like the VHA’s PAVE program (Prevention of Amputation in Veterans Everywhere), which aim to disseminate best practices across sites. But ultimately, as this study affirms, every clinic, every team, and every decision matters when it comes to saving limbs—and saving lives.
🔗 Full study (open access): Facility-Level Variation in Major Leg Amputation Among Patients With Newly Diagnosed Diabetic Foot Ulcer
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