A recent study found that the development of an interdisciplinary limb preservation service at a single county hospital led to a 40 percent decrease in high-level amputations (above the foot) and a 14 percent decrease in length of stay in comparison to care provided by a single surgical specialty-led diabetic amputation clinic at the same hospital.1
For the study, which was presented as a poster abstract at the recent 2021 Vascular Annual Meeting, researchers reviewed data from 1,143 lower extremity procedures in 1,125 patients who required diabetic foot surgery over a four-year period at one county hospital.1 Pyun and colleagues compared outcomes between patients treated by an interdisciplinary limb preservation team employing a “hot foot line” rapid referral pathway and those treated via single surgical specialty-led care. In addition to the decrease of amputations and length of stay, the study authors noted that the emergence of the interdisciplinary limb preservation team in the second year of the study led to a 4.2-fold increase in vascular surgery interventions and a 5.9-fold increase in outpatient procedures (with the most frequent podiatric surgery procedures being gastrocnemius recessions and metatarsal osteotomies).
“The increase in outpatient procedures was likely due to the transition of performing surgical procedures to heal wounds rather than wait for them to get infected, leading to an amputation,” asserts Tanzim Khan, DPM, a co-author of the study and an Assistant Professor of Clinical Surgery at the Keck School of Medicine at the University of Southern California. “Diabetic foot ulcers are most often caused by a biomechanical reason, and these surgical procedures help to rebalance pressure and heal the wounds. This is more important than simply performing wound care.”
According to the study, patients treated by the interdisciplinary limb salvage preservation service were 2.7 times more likely than those treated by the single specialty surgery-led cohort to have vascular surgery consultations prior to amputation.1 The study authors also noted that 25.2 percent of those in the interdisciplinary limb salvage preservation service cohort had non-invasive vascular studies prior to amputation in comparison to 18.1 percent of patients in the single surgical specialty treatment group.
Dr. Khan says the “hot foot line” rapid referral usually occurred within a 24-hour period but notes the more engaged collaboration between podiatric and vascular surgeons was key to the limb salvage outcomes documented in the study.
“The advantage that our interdisciplinary clinic has over the single surgical specialty-led providers is that we, as fellowship-trained limb salvage providers, have a more thorough understanding of noninvasive vascular studies and angiograms,” maintains Dr. Khan, the Head of the Limb Preservation Program at the Rancho Los Amigos National Rehabilitation Center in Los Angeles. “We also work with a team of vascular specialists that allow us to converse about patients in real time. This is different from a single surgical specialty provider who would likely put a vascular consult in and would wait for vascular to clear the patient and recommend a level of amputation. We’re making a more collaborative decision in limb preservation based on perfusion and, more importantly, function to determine the most optimal surgical procedures.”
- Pyun AJ, Khan T, D’Huyvetter KD, et al. Time is tissue: outcomes after implementation of an interdisciplinary integrated ‘hot foot line’ and limb preservation service. Poster presented at Vascular Annual Meeting; Aug. 18-21, 2021; San Diego.