Trends in the incidence of lower limb amputation after implementation of a Multidisciplinary Diabetic Foot Unit

Jiménez, Sara; Rubio, José António; Alvarez, Josefina; Ruiz-Grande, Fernando; Medina, Carlos

doi:10.1016/j.endien.2017.02.010

Cited by 10 publications

(29 citation statements)

References 24 publications

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“…Twenty-six studies that reported outcomes for podiatric interventions in an MDT context were included in this systematic review. Of these, 3 sets of articles were from the same group of authors, [35][36][37][38] and [39,40]. The decision was made to exclude the oldest ones, based on the fact that the same data set was used.…”

Section: Literature Searchmentioning

confidence: 99%

“…All 23 studies included in the systematic review were in English. We identified 6 studies from the United States [40,45,47,48,54,55], 2 from Canada [44,55] and 10 from Europe, of which 5 were from the United Kingdom [41,43,50,56,57], 2 from Spain [36,38], 1 from Sweden [51], 1 from the Netherlands [58] and 1 from Italy [49]. There were also 3 articles from Asia, of which 2 were from China [42,59] and 1 from Singapore [60].…”

Section: Description Of Included Articlesmentioning

confidence: 99%

“…Concerning the role of the podiatrist, we decided a posteriori to distinguish their role according to their implication in the MDT. With this in mind, the podiatrist intervenes in a primary role in 8 articles (leading role or core of the team) [36,43,44,47,48,54,55,59]. Specifically, in these articles, the podiatrist formed the core of the team with endocrinologists [36,59], nurses [43,55], and vascular surgeons [44,47,54].…”

Section: Description Of Included Articlesmentioning

confidence: 99%

See 2 more Smart Citations

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Blanchette

Brousseau-Foley

Cloutier

2020

Journal of Foot and Ankle Research

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Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity between team members and interventions. Podiatrists have been suggested as "gatekeepers" for the prevention and management of DFUs. The purpose of our study is to review the effect of podiatric interventions in MDTs on DFUs and LEAs. We conducted a systematic review of available literature. Data's heterogeneity about DFU outcomes made it impossible for us to include it in a meta-analysis, but we identified 12 studies fulfilling inclusion criteria that allowed for them to be included for LEA outcomes. With the exception of one study, all reported favourable outcomes for MDTs that include podiatry. We found statistical significance in favour of an MDT approach including podiatrists for our primary outcome (total LEAs (RR: 0.69, 95% CI 0.54-0.89, I 2 = 64%, P = 0.002)) and major LEAs (RR: 0.45, 95% CI 0.23-0.90, I 2 = 67%, P < 0.02). Our systematic review, with a standard search strategy, is the first to specifically address the relevant role of podiatrists and their interventions in an MDT approach for DFU management. Our observations support the literature that MDTs including podiatrists have a positive effect on patient outcomes but there is insufficient evidence that MDTs with podiatry management can reduce the risk of LEAs. Our study highlights the necessity for intervention descriptions and role definition in team approach in daily practice and in published literature.

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Section: Literature Searchmentioning

confidence: 99%

Section: Description Of Included Articlesmentioning

confidence: 99%

Section: Description Of Included Articlesmentioning

confidence: 99%

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Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Blanchette

Brousseau-Foley

Cloutier

2020

Journal of Foot and Ankle Research

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“…Evidence shows that a signi cant proportion of LEA in individuals with diabetes can be prevented by implementing effective multidisciplinary and multisectoral diabetes care programs [9]. Therefore, a reduction in the incidence of major LEA is a major health priority and considered a core indicator of the long-term quality of diabetes care worldwide [10].…”

mentioning

confidence: 99%

“…Therefore, a reduction in the incidence of major LEA is a major health priority and considered a core indicator of the long-term quality of diabetes care worldwide [10]. Data from national audits in many countries and the Organization for Economic Cooperation and Development (OECD) have demonstrated a signi cant reduction in the incidence of diabetes-related major LEA over years owing to diabetic foot ulcer prevention and care programs [9][10][11][12]. Nevertheless, studies have reported up to a 20-fold variation in the rate of major LEA among countries [13,14].…”

mentioning

confidence: 99%

Epidemiology of Major Lower Extremity Amputations in Individuals With Diabetes in Austria, 2014-2017: A Retrospective Analysis of Health Insurance Database

Aziz

Reichardt

Sourij

et al. 2020

Preprint

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Background: Previous data show a high incidence of major lower extremity amputations (LEA) in Austria. Moreover, recent data on the epidemiology of major LEA are sparse in the Country. This study estimated the incidence and mortality rates of major LEA and assessed risk factors of post major LEA mortality in individuals with diabetes.Methods: A retrospective cohort analysis of 507,180 individuals with diabetes enrolled in the Austrian Health Insurance between 2014 and 2017 was performed. Crude and age-standardized rates of major LEA (hip, femur, knee, lower leg) were estimated by extracting their procedure codes from the database. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause cumulative mortality after major LEA was estimated from the date of amputation till the date of death. Poisson regression was performed to compare rates by characteristics and assess the annual trend. The Cox-regression was performed to identify significant risk factors of all-cause mortality after major LEA.Results: A total of 2,165 individuals with diabetes underwent major LEA between 2014 and 2017. The mean age was amputees was 73.0 ±11.3 years, 62.7% were males, and 87.3% had a peripheral vascular disease (PVD). The overall age-standardized rate was 6.44 per 100,000 population. The rate increased with age (p<0.001) and was higher (p<0.001) in males (9.38) than females (5.66). The rate was 5.71 in 2014, 6.86 in 2015, 6.71 in 2016, and 6.66 in 2017, with an insignificant annual change of 3% (p=0.825). The cumulative 30-day mortality was 13.5%, 90-day was 22.0%, 1-year was 34.4%, and 5-year was 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, PVD, and renal disease were only associated with long-term mortality.Conclusions: The rate of major LEA remained stable between 2014 and 2017 in Austria. Short and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, heart failure, and Charlson Index were significant predictors of both short- and long-term mortality, whereas, comorbidities such as cancer, dementia, PVD, and renal disease were significant predictors of long-term mortality only.

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A multidisciplinary team reduces in‐hospital clinical complications and mortality in patients with diabetic foot ulcers

Meloni

Andreadi

Bellizzi

et al. 2023

Diabetes Metabolism Res

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AimsThe current study aims to evaluate the effectiveness of a multidisciplinary diabetic foot team (MDFT) in the management of in‐patients affected by diabetic foot problems.Materials and MethodsThe study was a retrospective observational study. Consecutive patients with a diabetic foot problem requiring hospitalisation were included. All patients were managed by a MDFT led by diabetologists according to the guidance. The rate of in‐hospital complications (IHCs), major amputation, and survival were recorded at the end of patient’s hospitalisation. IHC was defined as any new infection different from wound infection, cardiovascular events, acute renal injury, severe anaemia requiring blood transfusion, and any other clinical problem not present at the assessment.ResultsOverall, 350 patients were included. The mean age was 67.9 ± 12.6 years, 254 (72.6%) were males, 323 (92, 3%) showed Type 2 diabetes with a mean duration of 20.2 ± 9.6 years; 224 (64%) had ischaemic diabetic foot ulcers (DFUs) and 299 (85.4%) had infected DFUs. IHCs were recorded in 30/350 (8.6%) patients. The main reasons for IHCs were anaemia requiring blood transfusion (2.8%), pneumonia (1.7%), acute kidney failure (1.1%). Patients with IHCs showed a higher rate of major amputation (13.3 vs. 3.1%, p = 0.02) and mortality (16.7 vs. 0.6%, p < 0.0001) in comparison to those without. Ischaemic heart disease (IHD) and wound duration at the assessment (>1 month) were independent predictors of IHC, whereas IHCs, heart failure, and dialysis were independent predictors of in‐hospital mortality.ConclusionsThe multidisciplinary management of diabetic foot problems leads to an IHC rate of 8%. The risk of IHCs is higher in patients with IHD and long wound duration.

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Trends in the incidence of lower limb amputation after implementation of a Multidisciplinary Diabetic Foot Unit

Cited by 10 publications

References 24 publications

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Epidemiology of Major Lower Extremity Amputations in Individuals With Diabetes in Austria, 2014-2017: A Retrospective Analysis of Health Insurance Database

A multidisciplinary team reduces in‐hospital clinical complications and mortality in patients with diabetic foot ulcers

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