D. A. Watson1, C. A. Banks1, Z. Novak1, B. Haverstock1, K. Unger1, R. Harris1, D. Sutzko1, B. Pearce1, M. Passman1, M. Patterson1, A. W. Beck1, J. Rowse1, E. Spangler1 1University Of Alabama at Birmingham, Vascular Surgery And Endovascular Therapy, Birmingham, Alabama, USA
Introduction:
Traditionally, vascular surgeons performed lower extremity revascularization as well as podiatric interventions in patients with tissue loss with Chronic Limb Threatening Ischemia (CLTI). Podiatric surgeons joined our vascular surgery division to form a multidisciplinary team in 2018. The purpose of this study is to evaluate patient outcomes following the implementation of a multidisciplinary approach in managing patients with CLTI progressing to tissue loss.
Methods:
A single institution retrospective review was performed of all patients undergoing lower extremity revascularization and podiatric intervention for CLTI with tissue loss (Rutherford class 5/6) from 2015-2022 at a tertiary academic medical center. The cohort was divided into two groups: patients treated only by vascular surgery (pre-integration) and patients with multidisciplinary care. Kaplan-Meier analyses were used to evaluate differences in freedom from major amputation (above or below knee amputations), freedom from reintervention, freedom from readmission, and survival.
Results:
A total of 155 patients met cohort inclusion criteria (50 pre-integration and 105 multidisciplinary care). Demographics were similar between cohorts, however important differences included percentage of diabetic patients (68% pre-integration vs 85.7% multidisciplinary care; p=0.01) and percentage of patients with prior revascularization (53.1% pre-integration vs 33.3% multidisciplinary care; p=0.02). The multidisciplinary care group had modestly lower rates of 90-day freedom from reintervention (25% pre-integration vs 31%, multidisciplinary care, p=0.161) and freedom from readmission (44% pre-integration vs 55% multidisciplinary care, p=0.338) compared to their counterparts. Freedom from major amputation was significantly higher at 1-year with multidisciplinary care at 59% pre-integration vs 81% with multidisciplinary care (Log-rank=0.003) (Figure 1a). Compared to the multidisciplinary cohort, the pre-integration group experienced significantly decreased survival at 1-year (67% vs 89% respectively (Log-rank=0.002) (Figure 1b).
Conclusion:
Implementation of integrated vascular surgery and podiatric surgery multidisciplinary care at an academic medical institution involved more diabetic patients and patients without prior revascularizations than when vascular surgeons alone provided tissue loss care for CLTI. Better patient outcomes were observed regarding progression to major amputation and overall survival following the integration of podiatric and vascular services to provide multidisciplinary care.
