title: Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study.
abstract: OBJECTIVE
  Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data.
  
  
  METHODS
  The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years.
  
  
  RESULTS
  We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R2(without podiatry)=0.45, R2(with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; p<0.01) and an overall decrease in high-low amputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (p<0.05).
  
  
  CONCLUSIONS
  Our findings signify the importance of podiatric care in the diabetic population. With an established podiatry program present at an academic institution, major lower extremity amputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition.
authors.affiliation: University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States. Electronic address: bmcs@med.umich.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Schmidt
authors.affiliation: University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
authors.forename: James S
authors.initials: JS
authors.lastname: Wrobel
authors.affiliation: University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Munson
authors.affiliation: University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
authors.forename: Gary
authors.initials: G
authors.lastname: Rothenberg
authors.affiliation: University of Michigan Hospital and Health Systems, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300), 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, United States.
authors.forename: Crystal M
authors.initials: CM
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery; D005260:Female; D005528:Foot / Q000601:surgery; D006801:Humans; D023821:Limb Salvage / Q000379:methods / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011032:Podiatry; D012189:Retrospective Studies
keywords: Amputation; Diabetic foot; High:Low ratio; Podiatry