Organized programs to prevent lower-extremity amputations.
BACKGROUND
Diabetes-related lower-extremity amputations are largely preventable. Eighty-five percent of amputations are preceded by a foot ulcer. Effective management of ulcers, which leads to healing, can prevent limb loss.


METHODS
In a county hospital, we implemented a six-step approach to the diabetic limb at risk. We calculated the frequency and level of lower-extremity amputations for 12 months before and 12 months after implementation of the amputation prevention program. We also calculated the high-low amputation ratio for the years reviewed. The high-low amputation ratio is a quality measure for the success of amputation prevention measures and is calculated as the ratio of the number of high amputations (limb losses) over the number of low (partial foot) amputations.


RESULTS
The frequency of total amputations increased from 24 in year 1 to 46 in year 2. However, the number of limb losses decreased from 7 to 2 (72%). The high-low amputation ratio decreased eightfold in 1 year, which serves as a marker for limb salvage success.


CONCLUSIONS
Improvement in care organization and multidisciplinary-centered protocols can substantially reduce limb losses.
Rogers
Lee C
LC
Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA 91405, USA. Lee.C.Rogers@gmail.com
Bevilacqua
Nicholas J
NJ
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017719:Diabetic Foot / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D023821:Limb Salvage / Q000379:methods / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D012720:Severity of Illness Index