Outpatient foot care: correlation to amputation level.

A retrospective analysis of Department of Veterans Affairs automated inpatient and outpatient records was performed for 3945 patients who underwent lower extremity amputation surgery due to peripheral vascular disease during fiscal year 1991. Demographic and clinical data were collected from reviewing patient database information for all Department of Veterans Affairs Hospitals nationwide. Patients were identified from the Physicians' Current Procedural Terminology codes for lower extremity amputations, and then divided into three groups (above the knee, below the knee, and foot and ankle) based on the most proximal level of amputation performed. Results indicate that increased use of designated foot care clinics was significantly associated with more distal level amputation surgery. Patients with above-the-knee amputations averaged 1.0 foot care clinic visit in the 2 years prior to amputation, whereas below-the-knee and foot and ankle amputees averaged 2.8 and 5.3 foot care clinic visits, respectively (F[df = 2,3939] = 94.20, P < .05). The same finding was noted when only users of foot care clinics were examined. Patients with a codiagnosis of diabetes were more likely to undergo distal amputation than those with other diagnoses (P < .05). The results of this study suggest the potential effectiveness of designated foot care clinics in preserving limb length in individuals with peripheral vascular disease and diabetes.