Lo Zhiwen Joseph, Chandrasekar Sadhana, Yong Enming, Hong Qiantai, Zhang Li, Chong Lester Rhan Chaen, Tan Glenn, Chan Yam Meng, Koo Hui Yan, Chew Tiffany, Sani Nur Faezah, Cheong Keet Yeng, Cheng Leighton Ren Qin, Tan Audrey Hui Min, Muthuveerappa Sivakami, Lai Tina Peiting, Goh Cheng Cheng, Ang Gary Y, Zhu Zhecheng, Hoi Wai Han, Lin Jaime H X, Chew Daniel E K, Lim Brenda, Yeo Pei Shan, Liew Huiling
Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Lee Kong Chian School of Medicine Centre for Population Health Sciences, Nayang Technological University, Singapore.
Int Wound J. 2022 May;19(4):765-773. doi: 10.1111/iwj.13672. Epub 2021 Aug 6.
Present guidelines recommend a multidisciplinary team (MDT) approach to diabetic foot ulcer (DFU) care, but relevant data from Asia are lacking. We aim to evaluate the clinical and economic outcomes of an MDT approach in a lower extremity amputation prevention programme (LEAPP) for DFU care in an Asian population. We performed a case-control study of 84 patients with DFU between January 2017 and October 2017 (retrospective control) vs 117 patients with DFU between December 2017 and July 2018 (prospective LEAPP cohort). Comparing the clinical outcomes between the retrospective cohort and the LEAPP cohort, there was a significant decrease in mean time from referral to index clinic visit (38.6 vs 9.5 days, P < .001), increase in outpatient podiatry follow-up (33% vs 76%, P < .001), decrease in 1-year minor amputation rate (14% vs 3%, P = .007), and decrease in 1-year major amputation rate (9% vs 3%, P = .05). Simulation of cost avoidance demonstrated an annualised cost avoidance of USD $1.86m (SGD $2.5m) for patients within the LEAPP cohort. In conclusion, similar to the data from Western societies, an MDT approach in an Asian population, via a LEAPP for patients with DFU, demonstrated a significant reduction in minor and major amputation rates, with annualised cost avoidance of USD $1.86m.
目前的指南推荐采用多学科团队（MDT）方法来护理糖尿病足溃疡（DFU），但亚洲地区缺乏相关数据。我们旨在评估在一项针对亚洲人群DFU护理的下肢截肢预防计划（LEAPP）中，MDT方法的临床和经济效果。我们进行了一项病例对照研究，比较了2017年1月至2017年10月期间84例DFU患者（回顾性对照组）与2017年12月至2018年7月期间117例DFU患者（前瞻性LEAPP队列）的情况。比较回顾性队列和LEAPP队列的临床结果，从转诊到首次门诊就诊的平均时间显著缩短（38.6天对9.5天，P <.001），门诊足病随访增加（33%对76%，P <.001），1年小截肢率降低（14%对3%，P =.007），1年大截肢率降低（9%对3%，P =.05）。成本避免模拟显示，LEAPP队列中的患者每年可避免成本186万美元（250万新元）。总之，与西方社会的数据类似，在亚洲人群中，通过针对DFU患者的LEAPP采用MDT方法，小截肢率和大截肢率显著降低，每年可避免成本186万美元。
