ORIGINAL ARTICLE  RECENT DEVELOPMENTS IN THE MANAGEMENT OF CRITICAL LIMB ISCHEMIA 

The Journal of Cardiovascular Surgery 2019 December;60(6):662-71

DOI: 10.23736/S0021-9509.19.11091-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The effect of a multidisciplinary outpatient team approach on outcomes in diabetic foot care: a single center study

Eline HUIZING ¹ ✉, Michiel A. SCHREVE ¹, Willemijn KORTMANN ², Jan P. BAKKER ³, Jean Paul P. M. de VRIES ⁴, Çağdaş ÜNLÜ ¹

¹ Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands; ² Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands; ³ Deparment of Rehabilitation Medicine, Northwest Clinics, Alkmaar, the Netherlands; ⁴ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands

BACKGROUND: Recent studies showed no reduction in major amputation rates after introduction of a multidisciplinary team (MDT) approach for the treatment of diabetic foot ulcer. The efficacy of MDTs in the current standard of care is being questioned. This retrospective single-center study evaluated the efficacy of an outpatient MDT approach on limb salvage and ulcer healing in treating diabetic foot ulcers.
METHODS: Patients with a diabetic foot ulcer treated before (2015) and after (2017) implementation of an MDT in a single center were compared. The MDT met weekly and consisted of a vascular surgeon, physiatrist, internist, shoe technician, wound care nurse, nurse practitioner, cast technician, and podiatrist. The primary outcome was limb salvage at 1 year. Secondary outcomes were ulcer healing, amputation-free survival, freedom from any amputation, and overall survival. Multivariable Cox regression models were used to assess predictors for major amputation.
RESULTS: A vascular surgeon treated 104 patients with 148 ulcers in 2015, and the multidisciplinary team treated 133 patients with 188 ulcers in 2017. Limb salvage (90.9% vs. 95.5%, P=0.050), freedom from any amputation (56.5% vs. 78.0%, P<0.001), and ulcer healing (48.3% vs. 69.2%, P<0.001) were significantly lower in the non-MDT group than in the MDT group. Amputation-free survival and overall survival did not differ significantly between the groups. Predictors for major amputation were University of Texas Wound Classification 3D (hazard ratio, 2.8; 95% confidence interval, 1.17-6.45) and being treated in the non-MDT group (hazard ratio, 3.7; 95% confidence interval, 1.25-11.08).
CONCLUSIONS: This retrospective study found an MDT dedicated to diabetic foot care was highly effective in increasing limb salvage and ulcer healing. We advise that such an MDT is an integrated part of the patient’s chain-based care.

KEY WORDS: Diabetic foot; Ulcer; Limb salvage; Wound healing; Amputation; Peripheral arterial disease