Multidisciplinary Amputation Prevention at the DeBakey VA Hospital: Our First Decade.

BACKGROUND

In 2011, the Veterans Health Administration (VHA) undertook multidisciplinary efforts to improve care for patients with nonhealing foot ulcers and reduce leg amputation rates. This article examines the impact of interdisciplinary care for amputation prevention in the VHA.

METHODS

The VHA patient population was characterized using internal registries. Texas hospital admission data were used to identify sex and zip-code matched cohorts. VHA provided data on national and local frequencies of various amputations and the number of patients with diabetes.

RESULTS

Compared to matched nonveteran patients, veterans treated at VHA hospitals were older and more often self-identified as Black. They also had significantly higher rates of diabetes, chronic kidney disease, and systolic heart failure. A decrease from 160 to 66 amputations per 100,000 was seen from 2012 to 2017 (a 60% reduction) after implementing interdisciplinary care. Several evidence-directed practices were implemented during the study period. The proportion of angiograms for foot ulcers or gangrene increased from 28.9% to 90.9%.

CONCLUSIONS

Interdisciplinary care can significantly reduce leg amputation rates. This reduction does not seem dependent on a particular model for providing inpatient care.