Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan

Abstract

To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group‐A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group‐B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Total 7994 DFU cases seen, 888 in group A and 7106 in group B. Mean age of patients was 53.80 ± 10.40 years and mean haemoglobin (HbA1c) was 10.12 ± 2.44. Overall, decreasing trends of amputations were observed from baseline 27.5% to 3.92% during the period of 20 years. In group A, 479 (78.8%) subjects healed completely compared with 3806 (89.1%) in group B. Significant reduction in toe amputations ([13.81%] vs [8.11%]) and below knee amputations [(5.26%) vs (1.82%)] were seen. Similarly, rates of above knee amputation ([1.80%] vs [0.35%] P‐value 0.008) in two groups was also significant. Significant improvement was observed in outcomes of DFU in terms of amputation through multidisciplinary team approach.

Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis

“…Only seven of the studies were included in the metaanalysis [25][26][27][28][29][30][31], as they reported the number of cases of LEA as well as the population denominator (not as rate) for both the intervention and control groups (either in parallel or before vs after). The results obtained from the meta-analysis are presented in Fig.…”

“…Four studies [25][26][27][28] reported a decrease in the number of major LEAs while at the same time reporting either no difference or a slight increase in minor LEAs. Since data in these studies were aggregated, it was not possible to discern whether the increase in minor LEAs was due to multiple sequential minor amputations on the same patients.…”

“…Among them, observational studies had a longer duration and larger sample sizes. Therefore, their likelihood of reporting significant results was higher, with a larger magnitude of the effect that could be affected by bias [26,27,29]. Also, some observational designs reflect reallife data derived from electronic medical records (EMRs).…”

“…Studies also presented variation in target outcomes. Four studies [25][26][27]29] reported significant reduction of major amputations, associated with either an increase or a nonsignificant decrease in minor amputations. Due to the limitations of study reporting, it was not possible to assess the impact of patient profiles, e.g.…”

A limb is a peninsula and no clinician is an island: Introducing the American Limb Preservation Society (ALPS)

“…[6][7][8] With the recent advent of the team approach to limb preservation, investigational and clinical efforts to promote an interprofessional approach to limb preservation are accelerating globally. [9][10][11][12][13][14][15] While podiatric and vascular surgery are indisputably key components to amputation prevention teams, 15 unnecessary amputations remain a substantial challenge and a correspondingly substantial team is required to meet this foe. Diabetes educators, endocrinologists, infectious disease specialists, interventional radiologists and cardiologists, nurses, pathologists, pedorthists, physical therapists, plastic surgeons, clinical scientists, and many others are valiantly working to save limbs.…”