Williams Dean T, Majeed Muhammad U, Shingler Guy, Akbar Mohammed J, Adamson Diane G, Whitaker Christopher J
Department of Vascular Surgery, Ysbyty Gwynedd Hospital, Bangor, Gwynedd, UK.
Ann Vasc Surg. 2012 Jul;26(5):700-6. doi: 10.1016/j.avsg.2011.10.020. Epub 2012 Apr 12.
The mechanism by which the multidisciplinary approach to diabetic foot disease reduces amputation rates is unclear. Ischemia, sepsis, and necrosis represent aspects of severe diabetic foot disease amenable to intervention. In 2006, a vascular unit introduced a rapid access service for severe foot disease, augmenting the established community provision. This study aimed to determine whether concurrent changes in amputation rates were observed, and to identify areas that may have influenced outcomes.
Unit data prospectively collected during 4 years for patients with lower-limb disease were compared with data retrieved over 2 years before the foot service. Outcome measurements were major amputations, foot surgery, vascular interventions, admissions, and length of stay.
Major amputation rates associated with diabetes peaked in 2005 at 24.7/10,000 vs. 1.07/10,000 in 2009; (relative risk = 0.043, 95% confidence interval = 0.006-0.322). The proportion of diabetic to nondiabetic amputations decreased; foot surgery rates also dropped (53.7/10,000 in 2006 vs. 7.5/10,000 in 2009). The number of open revascularization procedures decreased, but the rates of endovascular procedures remained generally constant. Hospital admission rates decreased after initially peaking, and the length of stay was unchanged (16 vs. 15.5 days in 2004 and 2009, respectively).
The integration of a vascular unit with community care has been associated with improved outcomes for patients with diabetic foot disease. Improvements were not related to the increased number of vascular procedures or hospitalizations, but did coincide with a greater proportion of patients attending the foot unit. The referral of patients to the unit facilitates the rapid management of severe disease, reducing delays deleterious to outcomes.
多学科方法治疗糖尿病足病降低截肢率的机制尚不清楚。缺血、败血症和坏死是严重糖尿病足病中适合干预的方面。2006年，一个血管科为严重足部疾病引入了快速就诊服务，加强了已有的社区服务。本研究旨在确定是否观察到截肢率的同时变化，并确定可能影响结果的领域。
将4年期间前瞻性收集的下肢疾病患者的科室数据与足部服务开展前2年检索到的数据进行比较。结果测量指标为大截肢、足部手术、血管介入、住院次数和住院时间。
与糖尿病相关的大截肢率在2005年达到峰值，为24.7/10000，而2009年为1.07/10000；（相对风险=0.043，95%置信区间=0.006-0.322）。糖尿病截肢患者与非糖尿病截肢患者的比例下降；足部手术率也下降（2006年为53.7/10000，2009年为7.5/10000）。开放性血管重建手术的数量减少，但血管内手术的发生率总体保持不变。住院率在最初达到峰值后下降，住院时间没有变化（2004年和2009年分别为16天和15.5天）。
血管科与社区护理的整合与糖尿病足病患者的预后改善相关。改善与血管手术或住院次数的增加无关，但确实与更多患者前往足部科室就诊相吻合。将患者转诊至该科室有助于对严重疾病进行快速管理，减少对预后有害的延误。
