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

Abstract

Objective: The objective of this study was to evaluate the impact of a multidisciplinary team (MDT) approach in the management of diabetic foot ulcers (DFUs). Approach: A multidisciplinary diabetic foot care center (MDDFCC) was opened at our institution in August 2018. Outcomes of DFU treatment, including re-admission, amputation, and mortality rates, were compared before and after opening the MDDFCC. Results: Patients seen after the MDDFCC was opened had a lower risk of 1-year re-admission (hazard ratio [HR] = 0.697, 95% confidence interval [CI]: 0.387-0.988), 1-year major amputation (HR = 0.447, 95% CI: 0.091-0.984), and 1-year disease-specific mortality (HR = 0.277, 95% CI: 0.105-0.730). PEDIS score (HR = 2.343, 95% CI: 1.264-2.971), history of dialysis (HR = 1.858, 95% CI: 1.258-4.053), and consultation with a physiatrist (HR = 0.368, 95% CI: 0.172-0.788), orthopedist (HR = 0.105, 95% CI: 0.042-0.261), or social worker (HR = 0.370, 95% CI: 0.082-0.871) were associated with 1-year major amputation. One-year major amputation (HR = 2.636, 95% CI: 1.586-4.570), age (HR = 1.094, 95% CI: 1.051-1.140), and C-reactive protein level (HR = 1.052, 95% CI: 1.008-1.098) were associated with 1-year disease-specific mortality. Innovation: Plastic surgeons received patients at the MDDFCC, with active participation by all contributing members. This arrangement brought advantages, including more aggressive and timely surgical intervention, a more timely and higher rate of percutaneous transluminal angioplasty, and equally robust integrated medical care by all other members. Conclusion: The MDDFCC approach may be a potential organizational structure with for treating DFUs, resulting in significant improvements in outcomes of DFU including a lower re-admission, amputation, and mortality.