Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates

Cardiovascular Diabetology

Original Investigation

Markolf Hanefeld¹  Carsta Koehler¹  Antje Thomas¹  Andrej Brechow²  Torsten Slesaczeck²  Matthias Weck³  Ulf Dietrich⁴  Mandy Holfert⁴  Dirk Muench⁵  Thomas Nanning⁵  Hartmut Paetzold⁶  Georg von Gagern⁶  Stefan Bornstein⁷  Andreas Barthel⁸ 

[1] Center for Clinical Studies, Technical University GWT-TUD GmbH Dresden, Dresden, Germany;Department of Diabetes, Interdisciplinary Diabetic Foot Unit, Weisseritztal-KlinikenFreital, Germany;Department of Diabetes, Interdisciplinary Diabetic Foot Unit, Weisseritztal-KlinikenFreital, Germany;Department of Diabetes, Metabolism and Endocrinology, Clinic Bavaria Kreischa, Kreischa, Germany;Department of Diabetes, Metabolism and Endocrinology, Clinic Bavaria Kreischa, Kreischa, Germany;Department of Interventional Angiology, Weisseritztal-Kliniken, Freital, Germany;Department of Vascular Surgery, Weisseritztal-Kliniken, Freital, Germany;Technical University Dresden, III Medical Clinic, Dresden, Germany;Technical University Dresden, III Medical Clinic, Dresden, Germany;Endokrinologikum, Bochum, Germany;

关键词: Critical Limb Ischemia;    Major Amputation;    Lower Extremity Amputation;    Rehabilitative Treatment;    Minor Amputation;   

DOI  :  10.1186/1475-2840-12-45

 received in 2012-12-10, accepted in 2013-02-20,  发布年份 2013

来源: Springer

【 摘 要 】

ObjectiveWe tested the effects of structured health care for the diabetic foot in one region in Germany aiming to reduce the number of major amputations.Research design and methodsIn a prospective study we investigated patients with diabetic foot in a structured system of outpatient, in-patient and rehabilitative treatment. Subjects were recruited between January 1st, 2000 and December 31, 2007. All participants underwent a two-year follow-up. The modified University of Texas Wound Classification System (UT) was the basis for documentation and data analysis. We evaluated numbers of major amputations, rates of ulcer healing and mortality. In order to compare the effect of the structured health care program with usual care in patients with diabetic foot we evaluated the same parameters at another regional hospital without interdisciplinary care of diabetic foot (controls).Results684 patients with diabetic foot and 508 controls were investigated. At discharge from hospital 28.3% (structured health care program, SHC) vs. 23.0% (controls) of all ulcers had healed completely. 51.5% (SHC) vs. 49.8% (controls) were in UT grade 1.Major amputations were performed in 32 subjects of the structured health care program group (4.7%) vs. 110 (21.7%) in controls (p<0.0001). Mortality during hospitalization was 2.5% (SHC) vs. 9.4% in controls (p<0.001).ConclusionsWith the structured health care program we achieved a significant reduction of major amputation rates by more than 75% as compared to standard care.

【 授权许可】

CC BY   
© Weck et al.; licensee BioMed Central Ltd. 2013