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Decreasing Amputation Rates in Patients with Diabetes Mellitus

An Outcome Study

Dessie D. Meltzer, MS, ARNP^*, Simon Pels, DPM, Wyatt G. Payne, MD, Rudolph J. Mannari, PA-C, Diane Ochs, RN^||, Jacquelyn Forbes-Kearns, MS, RN^¶ and Martin C. Robson, MD^**

^* Research Nurse, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL.
Staff Podiatrist, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL.
Associate Professor, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL, and Department of Surgery, University of South Florida, Tampa. Mailing address: Surgical Service (112), Bay Pines Veterans Affairs Medical Center, 10,000 Bay Pines Blvd, Bay Pines, FL 33744.
Physician’s Assistant, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL.
^|| Research Nurse, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL, and Department of Surgery, University of South Florida, Tampa.
^¶ Staff Nurse, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL.
^** Professor Emeritus, Institute for Tissue Regeneration, Repair, and Rehabilitation, Department of Veterans Affairs, Bay Pines, FL, and Department of Surgery, University of South Florida, Tampa.

Abstract

The lower-extremity amputation rate in people with diabetes mellitus is high, and the wound failure rate at the time of amputation is as high as 28%. Even with successful healing of the primary amputation site, amputation of part of the contralateral limb occurs in 50% of patients within 2 to 5 years. The purpose of this study was to provide valid outcome data before (control period) and 18 months after (test period) implementation of a multidisciplinary team approach using verified methods to improve the institutional care of wounds. Retrospective medical chart review was performed for 118 control patients and 116 test patients. The amputation rate was significantly decreased during the test period, and the amputations that were required were at a significantly more distal level. No above-the-knee amputations were required in 45 patients during the test period, compared with 14 of 76 patients during the control period. These outcome data suggest that unified care is an effective approach for the patient with diabetic foot problems. (J Am Podiatr Med Assoc 92(8): 425-428, 2002)

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