Abstract
References
- 1 -Cahn A, Elishuv O, Olshtain‐Pops K. Establishing a multidisciplinary diabetic foot team in a large tertiary hospital: a workshop. Diabetes Metab Res Rev. 2014;30:350–3. DOI:10.1002/dmrr.2527
- 2 -Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 2012;41:384–97. DOI:10.1007/s12020-012-9619-x
- 3- Bakker K, Apelqvist J, Schaper NC, et al. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28 Suppl 1:225–31. DOI:10.1002/dmrr.2253
- 4- Doğan Aslan M, Çulha C, Yanıkoğlu İ, et al. Clinical and demographic characteristics of patients with lower limb amputation. Ege Tıp Derg. 2019;58:46–51. DOI:10.19161/etd.418181
- 5-Keszler MS, Wright KS, Miranda A, et al. Multidisciplinary amputation team management of individuals with limb loss. Curr Phys Med Rehabil Rep. 2020;8:118–26. DOI:10.1007/s40141-020-00282-4
- 6- Ziegler-Graham K, MacKenzie EJ, Ephraim PL, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89:422–9. DOI:10.1016/j.apmr.2007.11.005
- 7- Meier RH, Heckman JT. Principles of contemporary amputation rehabilitation in the United States, 2013. Phys Med Rehabil Clin N Am. 2014;25:29–33. DOI:10.1016/j.pmr.2013.09.004
- 8- Esquenazi A. Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration. Disabil Rehabil. 2004;26:831–6. DOI:10.1080/09638280410001708850
- 9- Condie NV, Ambler GK. Re-amputation: time for major revision of current practice? Eur J Vasc Endovasc Surg. 2020;60:622. DOI:10.1016/j.ejvs.2020.05.013
- 10- Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69:3S-125S.e40. DOI:10.1016/j.jvs.2019.02.016
- 11- Tuglo LS. Prevalence and determinants of lower extremity amputations among type I and type II diabetic patients: a multicenter‐based study. Int Wound J. 2023;20:903–9. DOI:10.1111/iwj.13935
- 12- Norvell DC, Czerniecki JM. Risks and risk factors for ipsilateral re-amputation in the first year following first major unilateral dysvascular amputation. Eur J Vasc Endovasc Surg. 2020;60:614–21. DOI:10.1016/j.ejvs.2020.06.026
- 13- Font-Jiménez I, Llaurado-Serra M, Roig-Garcia M, et al. Retrospective study of the evolution of the incidence of non-traumatic lower-extremity amputations (2007-2013) and risk factors of reamputation. Prim Care Diabetes. 2016;10:434–41. DOI:10.1016/j.pcd.2016.04.001
- 14- Huizing E, Schreve MA, Kortmann W, et al. The effect of a multidisciplinary outpatient team approach on outcomes in diabetic foot care: a single center study. J Cardiovasc Surg (Torino). 2020;60. DOI:10.23736/S0021-9509.19.11091-9
- 15- Musuuza J, Sutherland BL, Kurter S, et al. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg. 2020;71:1433-1446.e3. DOI:10.1016/j.jvs.2019.08.244
- 16- Hamonet J, Verdié-Kessler C, Daviet J-C, et al. Evaluation of a multidisciplinary consultation of diabetic foot. Ann Phys Rehabil Med. 2010;53:306–18. DOI:10.1016/j.rehab.2010.04.001
- 17- Lepäntalo M, Biancari F, Tukiainen E. Never amputate without consultation of a vascular surgeon. Diabetes Metab Res Rev. 2000;16 Suppl 1:27-32. DOI:10.1002/1520-7560(200009/10)16:1+<::aid-dmrr107>3.0.co;2-h
- 18- Poehler D, Czerniecki J, Norvell D, et al. The development and pilot study of a multiple criteria decision analysis (MCDA) to compare patient and provider priorities around amputation-level outcomes. MDM Policy Pract. 2022;7:2. DOI:10.1177/23814683221143765
- 19- Poehler D, Czerniecki J, Norvell D, et al. Comparing patient and provider priorities around amputation level outcomes using multiple criteria decision analysis. Ann Vasc Surg. 2023;95:169–77. DOI:10.1016/j.avsg.2023.05.026
- 20- Wang S-Y, Liu J-F, Huang Y-P, et al. The diabetic foot amputation decision-making process. Adv Skin Wound Care. 2018;31:413–20. DOI:10.1097/01.ASW.0000542526.41192.c0
Optimizing Lower Extremity Amputation Outcomes: The Impact of Multidisciplinary Consultations on Revision Rates in Non-Traumatic Lower Extremity Amputations
Abstract
Background/Purpose: Amputation is not merely a limb-saving surgery; it can also impose a significant burden on the healthcare system due to psychological issues and the need for prolonged, recurrent hospitalizations. Revision surgeries following lower extremity amputations continue to occur at high rates. Our study aims to identify the factors leading to revision after non-traumatic lower extremity amputations and determine whether the level of the initial amputation was accurately determined by examining the correlation between these revisions and recommendations from multidisciplinary consultations (MDC).
Methods: This retrospective study included diabetic foot patients undergoing below-knee amputations between 2016 and 2021. Two groups were formed: the revision group (35 patients transitioning from transtibial to transfemoral amputation) and the control group (35 patients with initial amputations). Gender, etiology, amputation levels, time to revision, follow-up, vascular status, and multidisciplinary consultations were analyzed. The MDC team for determining the amputation levels involved orthopedics, cardiovascular surgery, plastic surgery, and infectious diseases. Each patient's adherence to the MDC recommendation level was analyzed.
Results: The average follow-up time was 4.84 years. Amputation level, revision/control group status, and variables such as year, age group, and gender were independent of each other. All amputations in the revision group (100%, n=35) were transtibial. In the control group, 20% (n=7) were at the transfemoral level and 80% (n=28) were at the transtibial level. MDC recommended transfemoral amputation (TFA) to 80% (n=28) and transtibial amputation (TTA) to 20% (n=7) of participants in the revision group. MDC recommended TFA to 20% (n=7) and TTA to 80% (n=28) of participants in the control group. Of the total sample, 60% (n=42) underwent surgery aligning with MDC guidelines, while 40% (n=28) underwent procedures deviating from the recommended level. All patients (n=28, 100%) not adhering to MDC recommendations underwent revision. Conversely, among those adhering to recommendations, 83.3% (n=35) did not require revision, while only 16.7% (n=7) required it, showcasing a significant decrease in revision need when adhering to MDC recommendations (p<0.0001).
Conclusion: Non-compliance with MDC recommendations was strongly linked to the necessity for revisions, whereas adherence significantly decreased this need. Additionally, patients under 65, males, and those recommended transtibial amputations by MDC experienced longer revision-free intervals. These findings underscore the significance of following MDC-recommended levels, helping patients and their families make informed decisions regarding higher amputation levels as the initial surgery.
Level of Evidence: Level 3 (a retrospective cohort study)
Keywords
Amputation Non-Traumatic Lower Extremity Amputations diabetic foot diabetic ulcer re-amputation amputation level amputation revision surgery multidisciplinary consultation
References
- 1 -Cahn A, Elishuv O, Olshtain‐Pops K. Establishing a multidisciplinary diabetic foot team in a large tertiary hospital: a workshop. Diabetes Metab Res Rev. 2014;30:350–3. DOI:10.1002/dmrr.2527
- 2 -Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 2012;41:384–97. DOI:10.1007/s12020-012-9619-x
- 3- Bakker K, Apelqvist J, Schaper NC, et al. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28 Suppl 1:225–31. DOI:10.1002/dmrr.2253
- 4- Doğan Aslan M, Çulha C, Yanıkoğlu İ, et al. Clinical and demographic characteristics of patients with lower limb amputation. Ege Tıp Derg. 2019;58:46–51. DOI:10.19161/etd.418181
- 5-Keszler MS, Wright KS, Miranda A, et al. Multidisciplinary amputation team management of individuals with limb loss. Curr Phys Med Rehabil Rep. 2020;8:118–26. DOI:10.1007/s40141-020-00282-4
- 6- Ziegler-Graham K, MacKenzie EJ, Ephraim PL, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89:422–9. DOI:10.1016/j.apmr.2007.11.005
- 7- Meier RH, Heckman JT. Principles of contemporary amputation rehabilitation in the United States, 2013. Phys Med Rehabil Clin N Am. 2014;25:29–33. DOI:10.1016/j.pmr.2013.09.004
- 8- Esquenazi A. Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration. Disabil Rehabil. 2004;26:831–6. DOI:10.1080/09638280410001708850
- 9- Condie NV, Ambler GK. Re-amputation: time for major revision of current practice? Eur J Vasc Endovasc Surg. 2020;60:622. DOI:10.1016/j.ejvs.2020.05.013
- 10- Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69:3S-125S.e40. DOI:10.1016/j.jvs.2019.02.016
- 11- Tuglo LS. Prevalence and determinants of lower extremity amputations among type I and type II diabetic patients: a multicenter‐based study. Int Wound J. 2023;20:903–9. DOI:10.1111/iwj.13935
- 12- Norvell DC, Czerniecki JM. Risks and risk factors for ipsilateral re-amputation in the first year following first major unilateral dysvascular amputation. Eur J Vasc Endovasc Surg. 2020;60:614–21. DOI:10.1016/j.ejvs.2020.06.026
- 13- Font-Jiménez I, Llaurado-Serra M, Roig-Garcia M, et al. Retrospective study of the evolution of the incidence of non-traumatic lower-extremity amputations (2007-2013) and risk factors of reamputation. Prim Care Diabetes. 2016;10:434–41. DOI:10.1016/j.pcd.2016.04.001
- 14- Huizing E, Schreve MA, Kortmann W, et al. The effect of a multidisciplinary outpatient team approach on outcomes in diabetic foot care: a single center study. J Cardiovasc Surg (Torino). 2020;60. DOI:10.23736/S0021-9509.19.11091-9
- 15- Musuuza J, Sutherland BL, Kurter S, et al. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg. 2020;71:1433-1446.e3. DOI:10.1016/j.jvs.2019.08.244
- 16- Hamonet J, Verdié-Kessler C, Daviet J-C, et al. Evaluation of a multidisciplinary consultation of diabetic foot. Ann Phys Rehabil Med. 2010;53:306–18. DOI:10.1016/j.rehab.2010.04.001
- 17- Lepäntalo M, Biancari F, Tukiainen E. Never amputate without consultation of a vascular surgeon. Diabetes Metab Res Rev. 2000;16 Suppl 1:27-32. DOI:10.1002/1520-7560(200009/10)16:1+<::aid-dmrr107>3.0.co;2-h
- 18- Poehler D, Czerniecki J, Norvell D, et al. The development and pilot study of a multiple criteria decision analysis (MCDA) to compare patient and provider priorities around amputation-level outcomes. MDM Policy Pract. 2022;7:2. DOI:10.1177/23814683221143765
- 19- Poehler D, Czerniecki J, Norvell D, et al. Comparing patient and provider priorities around amputation level outcomes using multiple criteria decision analysis. Ann Vasc Surg. 2023;95:169–77. DOI:10.1016/j.avsg.2023.05.026
- 20- Wang S-Y, Liu J-F, Huang Y-P, et al. The diabetic foot amputation decision-making process. Adv Skin Wound Care. 2018;31:413–20. DOI:10.1097/01.ASW.0000542526.41192.c0
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | September 17, 2024 |
| Publication Date | October 1, 2024 |
| Submission Date | June 15, 2024 |
| Acceptance Date | August 10, 2024 |
| Published in Issue | Year 2024 |