2372. Multidisciplinary Care Teams to Reduce Major Amputations for Patients with Diabetic Foot Ulcers: a Systematic Review
Session: Poster Abstract Session: Skin and Skin Structure Infection
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • 2372_IDWPOSTER.pdf (657.6 kB)
  • Background: Approximately 2 million Americans develop a diabetic foot ulcer (DFU) annually; >50% die and 5% lose a limb within 5 years. IDSA guidelines recommend multidisciplinary team care for these patients (moderate evidence). Little is known about who should compose the team or how the team should function (low evidence). We conducted a systematic review following PRISMA guidelines to evaluate the effect of multidisciplinary team care on major amputation in patients with DFU’s and describe team composition and function.

    Methods: A medical reference librarian searched databases without date limits through 05/26/2017. Two independent reviewers screened abstracts and then full text using the following inclusion criteria: original article; reported the effect of multidisciplinary teams (≥2 specialties) on major amputation; included a control group; >50% of study patients had diabetes; in English. Abstracted data included study design, patient characteristics, team composition and function, and major amputation rates.

    Results: We included 33 studies (Fig 1). Five (15%) were in the United States, and 27 (82%) were historically controlled trials. Thirty-two (97%) documented lower major amputation rates among patients cared for by a multidisciplinary team (Fig. 2). Relative reductions ranged from 11-90%. A 12% relative increase was observed in the single study documenting increased rates of major amputation following multidisciplinary care.  Thirty-six different specialties were represented in the 26 studies reporting team composition, including: endocrinology (85%), vascular surgery (73%), orthopedic surgery (65%), podiatry (54%), and infectious disease (50%). Teams functioned in the following settings: inpatient (30%), outpatient (15%), or both (55%). Among 12 studies reporting team function, the following topics were addressed: surgical debridement/offloading (66%), vascular disease (63%), infection (59%), and glycemic control (41%).

    Conclusion: Care by multidisciplinary teams may help prevent major amputation for patients with DFU’s. Team composition and function, and reductions in major amputation rates, varied considerably. Research directly comparing different models of multidisciplinary care is needed.  

     

    Meghan Brennan, MD1,2, Bryn Sutherland, BA1, Jackson Musuuza, MD, MPH, MS2, Bradley Smith, MD1, Prakash Balasubramanian, MD2, Suleyman Kurter, DPM2, Christopher Crnich, MD, PhD2,3 and Nasia Safdar, MD, PhD1,2, (1)University of Wisconsin, Madison, WI, (2)William S Middleton Memorial Veterans Hospital, Madison, WI, (3)University of Wisconsin School of Medicine and Public Health, Madison, WI

    Disclosures:

    M. Brennan, None

    B. Sutherland, None

    J. Musuuza, None

    B. Smith, None

    P. Balasubramanian, None

    S. Kurter, None

    C. Crnich, None

    N. Safdar, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.