Schmidt Brian M, Wrobel James S, Munson Michael, Rothenberg Gary, Holmes Crystal M
University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
Diabetes Res Clin Pract. 2017 Apr;126:272-277. doi: 10.1016/j.diabres.2017.02.008. Epub 2017 Feb 21.
Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data.
The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years.
We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R (without podiatry)=0.45, R (with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; p<0.01) and an overall decrease in high-low amputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (p<0.05).
Our findings signify the importance of podiatric care in the diabetic population. With an established podiatry program present at an academic institution, major lower extremity amputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition.
糖尿病并发症，包括下肢大截肢，可能对患者死亡率产生重大影响。本研究通过分析高低截肢率数据，确定在一所学术机构中，增加一个涉及足病学的肢体挽救和糖尿病足项目在16年期间产生了何种影响。
通过对一所学术机构电子病历的队列发现和16年计费分析，回顾性评估接受下肢非创伤性截肢的糖尿病患者群体的高低截肢率。
我们直接比较了两个时期，一个没有足病学服务，一个有足病学服务。结果发现，增加足病学项目后，肢体挽救率显著提高（无足病学服务时R = 0.45，有足病学服务时R = 0.26），每年的肢体挽救率有显著变化（分别为每年-0.11%和-0.36%；p<0.01），高低截肢率总体下降（无足病学服务时为0.89，有足病学服务时为0.60）。值得注意的是，增加足病学项目后，每年大约可避免40例下肢大截肢（p<0.05）。
我们的研究结果表明足病护理在糖尿病患者群体中的重要性。在学术机构建立足病学项目后，可以避免下肢大截肢，挽救更多肢体，从而预防该疾病的一些致命并发症。
