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Multiple Lower Extremity Salvage Procedures Do Not Delay Time To Amputation In Diabetics With Lower Extremity Wounds
Alexandra M. Vagonis, BA - University of Pittsburgh, Pittsburgh PA, USA
Joseph Mocharnuk, BS - University of Pittsburgh, Pittsburgh PA, USA
Pooja Humar, BS - University of Pittsburgh, Pittsburgh PA, USA
Yadira Villalvazo, MD, MS - University of Pittsburgh, Pittsburgh PA, USA
Yusuf Surucu, MD - University of Pittsburgh, Pittsburgh PA, USA
Kripa Venkatakrishnan, MPH - University of Pittsburgh, Pittsburgh PA, USA
Elizabeth Moroni, MD, MHA - University of Pittsburgh, Pittsburgh PA, USA
Brodie A. Parent, MD - University of Pittsburgh, Pittsburgh PA, USA
University of Pittsburgh Department of Plastic Surgery
2023-02-01
Presenter: Alexandra Vagonis
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. I verify that the research fellow has performed, analyzed, and written a substantial portion of the work included in this presentation.
Director Name: Brodie A. Parent
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE:Lower extremity (LE) wounds are costly and common sequelae of diabetes and vascular disease. These patients may require multiple operative interventions to achieve healing, but some progress to amputation. The current management paradigm for diabetic wound patients emphasizes limb salvage over early amputation. However, critical assessment of cost effectiveness, access disparities, and functional outcomes have raised challenges to this paradigm. This study aims to assess if undergoing multiple LE salvage procedures(LESP) has effects on amputation rates, time to amputation, and time to healing of diabetic wounds.
METHODS:A retrospective cohort study of diabetic patients with at least 1 non-traumatic LE wound and at least 1 LESP was conducted. Cohorts were arranged by number of LESPs. Cox regression was conducted to assess effects of multiple LESPs on time to amputation and time to wound healing. Other confounding variables (race, gender, glycemic control, nutrition, smoking, comorbidities, social vulnerability index) were accounted for in the analysis.
RESULTS:There was no significant difference in amputation rate between multiple and single LESP cohorts(73.5%vs.61.3%,p=0.097). Patients with poor glycemic control(HbA1c>7) had delayed time to healing compared to patients with more optimal control(HR=1.36,95%CI=1.136-1.514,p=0.04). Time to amputation was not significantly different between multiple and single LESP cohorts(HR=0.93,95%CI=0.608-1.418,p=0.7).
CONCLUSION:Based on these data, diabetic patients who undergo one limb salvage attempt versus multiple had no difference in amputation-free survival, suggesting that multiple surgical interventions may not be warranted. In the era of value-based care, while one salvage attempt may be warranted, multiple attempts may incur unnecessary costs and ultimately delay rehabilitation and recovery.
