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Negative-Pressure Wound Therapy and Diabetic Foot Amputations

A Retrospective Study of Payer Claims Data

Robert G. Frykberg, DPM, MPH ^* and David V. Williams, BA 

^* Podiatry Section, Carl T. Hayden Veterans Administration Medical Center, Phoenix, AZ.
Milliman Inc, Windsor, CT.

Corresponding author: Robert G. Frykberg, DPM, MPH, Podiatry Section, Carl T. Hayden Veterans Administration Medical Center, 650 E Indian School Rd, Phoenix, AZ 85012.

Abstract

Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers.

Methods: Administrative claims data for patients with diabetic foot ulcers from commercial payers (n = 3,524) and Medicare (n = 12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes. Risk-adjustment procedures were then performed to match patient risk categories (through total treatment costs) and wound severities (through debridement depth).

Results: The incidence of amputations in the NPWT groups was lower than that in the control groups. For the cost-based risk-adjustment analysis, amputation incidences with NPWT versus traditional therapy were 35% lower in the Medicare sample (10.8% versus 16.6%; P = .0077) and 34% lower in the commercial payer sample (14.1% versus 21.4%; P = .0951). Whereas overall amputation rates increased progressively with increasing wound debridement depth in both control groups, the same increasing trend did not occur in the NPWT groups.

Conclusions: Patients with diabetic foot ulcers in the Medicare sample treated with NPWT had a lower incidence of amputations than those undergoing traditional wound therapy; this finding was evident in wounds of varying depth in both populations studied. (J Am Podiatr Med Assoc 97(5): 351–359, 2007)

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				E. Udell Letters to the Editor: Negative-Pressure Wound Therapy and Diabetic Foot Amputations: A Retrospective Study of Payer Claims Data J Am Podiatr Med Assoc, March 1, 2008; 98(2): 164 - 165. [Full Text] [PDF]