Multidisciplinary Management Improves Re-Admission, Major Amputation, and Mortality Rates in Patients with Diabetic...

Area of Science:

• Podiatry
• Endocrinology
• Vascular Surgery
• Wound Care

Background:

• Diabetic foot ulcers (DFUs) represent a significant complication of diabetes, leading to high rates of morbidity and mortality.
• Effective management of DFUs requires a comprehensive, often multidisciplinary, approach to address the complex underlying factors.
• The establishment of specialized centers aims to consolidate expertise and resources for optimal DFU care.

Purpose of the Study:

• To evaluate the impact of a multidisciplinary team (MDT) approach on DFU management outcomes.
• To compare re-admission, amputation, and mortality rates before and after the implementation of a multidisciplinary diabetic foot care center (MDDFCC).

Main Methods:

• A retrospective analysis comparing DFU patient outcomes before and after the opening of an MDDFCC in August 2018.
• Outcomes assessed included 1-year re-admission, major amputation, and disease-specific mortality rates.
• Statistical analysis, including hazard ratios (HR) and 95% confidence intervals (CI), was used to determine the significance of various factors.

Main Results:

• Patients managed at the MDDFCC demonstrated a significantly lower risk of 1-year re-admission (HR=0.697), major amputation (HR=0.447), and disease-specific mortality (HR=0.277).
• Factors associated with 1-year major amputation included higher PEDIS scores, history of dialysis, and consultations with physiatrists, orthopedists, and social workers.
• Factors associated with 1-year disease-specific mortality included major amputation, older age, and elevated C-reactive protein levels.

Conclusions:

• The multidisciplinary diabetic foot care center (MDDFCC) approach is an effective organizational structure for treating diabetic foot ulcers.
• This integrated model leads to significant improvements in key outcomes, including reduced re-admission, amputation, and mortality rates.
• The MDDFCC facilitates more aggressive and timely interventions, such as surgical procedures and percutaneous transluminal angioplasty, alongside robust medical care.