The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot

David G. Armstrong, Manish Bharara, Matthew White, Brian Lepow, Sugam Bhatnagar, Timothy Fisher, Heather R. Kimbriel, Jodi Walters, Kaoru R. Goshima, John Hughes, Joseph L. Mills

Research output: Contribution to journalArticlepeer-review

83 Scopus citations


Objective: This study aimed to quantify the impact of an integrated diabetic foot surgical service on outcomes and changes in surgical volume and focus. Methods: We abstracted registry data from 48 consecutive months at a single institution, evaluating all patients with diabetic foot complications requiring surgery or vascular intervention, and compared outcomes in the 24months before and after integrating podiatric surgery with vascular surgical limb-salvage service. Results: The service performed 2923 operations; 790 (27.0%) were related to treatment of diabetic foot complications in 374 patients. Of these, 502 were classified as non-vascular diabetic foot surgery and 288 were vascular interventions. Urgent surgery was significantly reduced after team implementation (77.7% vs 48.5%, p<0.0001; OR=3.7, 95% CI: 2.4-5.5). The high/low amputation ratio decreased from 0.35 to 0.27 due to an increase in low-level (midfoot) amputations (8.2% vs 26.1%, p<0.0001; OR=4.0, 95% CI: 2.0-83.3). A 45.7% reduction in below-knee amputations was realized with a stable above-knee/below-knee amputation ratio (0.73-0.81). One-third of patients required vascular intervention. Vascular reconstructions increased 44.1% following institution of the team. Initial revascularization was endovascular in 70.6% of patients. Repeat endovascular intervention or conversion to open bypass was required in 37.1% of these patients, almost double the reintervention rate of those receiving open bypass first (18.9%). Conclusions: Interdisciplinary diabetic foot surgery teams may significantly impact surgery type, with greater focus on proactive and preventive, rather than reactive and ablative, procedures. Although endovascular limb-sparing procedures have become increasingly applicable, open bypass remains critical to success.

Original languageEnglish (US)
Pages (from-to)514-518
Number of pages5
JournalDiabetes/Metabolism Research and Reviews
Issue number6
StatePublished - Sep 2012


  • Amputation
  • Diabetic foot
  • Limb salvage
  • Revascularization
  • Wound healing

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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