Benefit of multidisciplinary wound care center on the volume and outcomes of a vascular surgery practice

• Published in: Journal of vascular surgery 2019-11, Vol.70 (5), p.1612-1619
• Main Authors: Flores, Alyssa M., Mell, Matthew W., Dalman, Ronald L., Chandra, Venita
• Format: Article
• Language: English
• Subjects: Aged; Amputation; Amputation - statistics & numerical data; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Endovascular Procedures - statistics & numerical data; Female; Health Plan Implementation; Humans; Ischemia - etiology; Ischemia - mortality; Ischemia - surgery; Kaplan-Meier Estimate; Limb salvage; Limb Salvage - methods; Limb Salvage - statistics & numerical data; Lower Extremity - blood supply; Lower Extremity - surgery; Male; Outpatient Clinics, Hospital - organization & administration; Outpatient Clinics, Hospital - statistics & numerical data; Patient Care Team - organization & administration; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - surgery; Practice Patterns, Physicians' - organization & administration; Practice Patterns, Physicians' - statistics & numerical data; Program Evaluation; Prospective Studies; Tertiary Care Centers - organization & administration; Tertiary Care Centers - statistics & numerical data; Treatment Outcome; Workload - statistics & numerical data; Wound care; Wound Healing
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2019.01.087

Multidisciplinary care is recommended for the treatment of patients with ischemic and diabetic wounds. In addition to integrating care from multiple specialties, outpatient wound care centers provide an opportunity for continuity and organization of care after revascularization or hospitalization. The purpose of this study was to assess changes in the practice patterns and outcomes of patients treated by a tertiary care vascular surgery practice after the introduction of an affiliated outpatient wound care center. A prospective institutional database was used to identify patients who underwent lower-extremity revascularization, amputation, or surgical debridement during consecutive 3-year periods before (BWC; n = 735) and after (AWC; n = 1503) the opening of an affiliated wound care center. Patients were included if they underwent intervention for atherosclerotic peripheral arterial disease or diabetic foot ulcers (DFUs). Changes in case volume, surgical indication, and procedural characteristics were assessed. Clinical outcomes included freedom from lower-extremity amputations and mortality. We identified a total of 1751 procedures performed in 1249 limbs that met inclusion criteria. After the opening of the wound clinic, procedures related to limb salvage represented a greater proportion of overall cases performed by the vascular service (19% vs 26%; P < .0001). The volume of lower-extremity interventions increased by 64%, from 662 procedures in the BWC period to 1085 procedures in the AWC period. There was no difference in type of revascularization performed between the two study periods, although surgical debridements (from 8.9% to 13%; P = .01) and infrapopliteal endovascular interventions (from 21% to 28%; P = .04) significantly increased. Compared with BWC patients, AWC patients more frequently presented with DFUs (7.3% vs 13%; P = .002) and chronic wounds (39% vs 45%; P = .05). At 1 year of follow-up, major amputation rates were significantly lower in the AWC group than in the BWC cohort (5.5% vs 8.8%; P = .04). Treatment during the AWC period was associated with a reduced risk of major amputation (adjusted hazard ratio, 0.41; 95% confidence interval, 0.27-0.62; P < .001), but no difference in all-cause mortality. The opening of an outpatient wound center affiliated with a tertiary vascular surgical practice was associated with a higher volume of limb salvage patients and procedures. The risk of major amputation decreased following the opening of t