A Call to Action: Enhancing Patient-Initiated Communication in Diabetic Below-Knee Amputation Cases for Improved Wound Center Outcomes.

OBJECTIVE

Patients undergoing below-knee amputation (BKA) for diabetic complications experience heightened anxiety and poor psychosocial outcomes. Though patient-initiated communication (PIC) clarifies uncertainty, it also increases clinical burden. Primary outcomes were PIC incidence within the perioperative period, PIC rationale, and PIC patient characteristics.

METHODS

From December 2021 to August 2023, a retrospective review of BKA patients analyzed PIC via phone calls and portal messages ±90 days of surgery. PIC patients were compared with non-PIC patients, with subgroup analysis of preoperative (pre-PIC) and postoperative (post-PIC) communication.

RESULTS

Of 151 BKA patients, 110 (72.8%) initiated 368 PIC encounters. Patients were predominantly male (68.2%), with a mean age of 57.8±13.8 years and a Charlson Comorbidity Index of 4.9±2.9. Pre-PIC (52.2%) was slightly more common than post-PIC (47.8%). PICs addressed administrative issues (37.2%), wound care (17.6%), and medications (19.3%). PIC patients were more likely to be discharged to rehabilitation or home ( P =.046), had shorter length of stay (LOS) [16 (10) vs. 18.5 (15) days, P =.0086], and returned to the operating room (ROR) within 30 days for complications ( P =.037). Multivariate analysis found discharge to home (OR: 6.00, P =.025) and ROR (OR: 0.256, P =.012) independently predicted PIC. Pre-PIC patients were more often married ( P =.038) and discharged home ( P =.045). Post-PIC patients had longer LOS ( P =.005) and fewer RORs ( P =.006).

CONCLUSIONS

Identifying high-risk groups and PIC rationale will improve the authors' institution's ability to address patient concerns.