Cited by 274Diabetic Foot Ulcer Assessment and ManagementInterprofessional Education and CollaborationPatient Safety and Medication Errors

A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers

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Musuuza, Jackson, Sutherland, Bryn L., Kurter, Suleyman, Balasubramanian, Prakash, Bartels, Christie M., Brennan, Meghan B.·2020·Journal of Vascular Surgery

Abstract

Objective Multiple single-center studies have reported significant reductions in major amputations among patients with diabetic foot ulcers after initiation of multidisciplinary teams. The purpose of this study was to assess the association between multidisciplinary teams (ie, two or more types of clinicians working together) and the risk of major amputation and to compile descriptions of these diverse teams.Methods We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials from inception through May 24, 2019 for studies reporting the association between multidisciplinary teams and major amputation rates for patients with diabetic foot ulcers. We included original studies if ≥50% of the patients seen by the multidisciplinary team had diabetes, they included a control group, and they reported the effect of a multidisciplinary team on major amputation rates. Studies were excluded if they were non-English language, abstracts only, or unpublished. We used the five-domain Systems Engineering Initiative for Patient Safety Model to describe team composition and function and summarized changes in major amputation rates associated with multidisciplinary team care. A meta-analysis was not performed because of heterogeneity across studies, their observational designs, and the potential for uncontrolled confounding (PROSPERO No. 2017: CRD42017067915).Results We included 33 studies, none of which were randomized trials. Multidisciplinary team composition and functions were highly diverse. However, four elements were common across teams: teams were composed of medical and surgical disciplines; larger teams benefitted from having a "captain" and a nuclear and ancillary team member structure; clear referral pathways and care algorithms supported timely, comprehensive care; and multidisciplinary teams addressed four key tasks: glycemic control, local wound management, vascular disease, and infection. Ninety-four percent (31/33) of studies reported a reduction in major amputations after institution of a multidisciplinary team.Conclusions Multidisciplinary team composition was variable but reduced major amputations in 94% of studies. Teams consistently addressed glycemic control, local wound management, vascular disease, and infection in a timely and coordinated manner to reduce major amputation for patients with diabetic foot ulcerations. Care algorithms and referral pathways were key tools to their success.

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Crossref · 10.1016/j.jvs.2019.08.244

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  • Early management of diabetic foot infection reduces the risk of hospitalization and amputation.

    “Early management of diabetic foot infection reduces the risk of hospitalization and amputation.78”

    From Diabetic Foot Ulcers (2023) · cites this paper as [78]

    The Conclusion (page unavailable) associates multidisciplinary care that addresses infection with a lower risk of major amputation in patients with severe diabetic foot ulcers. The paper does not establish that early management of infection alone reduces amputation risk, and it does not report a reduced risk of hospitalization; the Discussion instead describes care for patients whose ulcers are severe enough to warrant hospitalization. (LLM, conf=0.88)

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  • Data that detemir is safe in pregnancy are convincing.

    “Data that detemir is safe in pregnancy are convincing.1443–1446”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1446]

    The Discussion passage concerns multidisciplinary care and major amputations in patients with diabetic foot ulcers, not medication safety in pregnancy. Searches for “detemir safe in pregnancy” and “insulin detemir pregnancy safety” found no relevant passage in our copy; page numbers were not provided. (LLM, conf=0.78)

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  • In patients with chronic limb-threatening ischemia who require revascularization for tissue healing, delayed revascularization is associated with slower healing.

    “In patients with chronic limb-threatening ischemia who require revascularization for tissue healing, delayed revascularization is associated with slower healing.”

    From Diabetic Foot Ulcers (2023) · cites this paper as [78]

    The Results (Multidisciplinary Team Characteristics; page unavailable) say that teams could revascularize patients as needed, and the Discussion (page unavailable) considers whether increased revascularization contributed to fewer major amputations. Neither passage addresses whether delayed revascularization is associated with slower healing in patients with chronic limb-threatening ischemia. Searches for delayed revascularization and time to healing found no passage establishing that relationship. (LLM, conf=0.74)

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  • In a study of 668 patients with diabetic foot ulcer infection treated in a single hospital, each day of delay in referral to the medical center was associated with a 0.6% increased risk of major amputation or death (OR, 1.006; 95% CI, 1.003-1.010; P < .001).

    “In a study of 668 patients with diabetic foot ulcer infection treated in a single hospital, there was a 0.6% increased risk of major amputation or death for each day that referral to the medical center was delayed (OR, 1.006; 95% CI, 1.003-1.010;P< .001[absoluterates not provided]).78”

    From Diabetic Foot Ulcers (2023) · cites this paper as [78]

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  • In a prospective study of 478 patients, patients who received a referral for revascularization within 56 days had improved rate of wound healing compared with those with longer time to revascularization (HR, 1.96; 95% CI, 1.52-2.52; P < .001).

    “A prospective study of 478 patients identified an improved rate of wound healing among patients undergoing revascularization with shorter time to healing among those who received a referral for revascularization within 56 days compared with those who had a longer time to revascularization (hazard ratio [HR], 1.96; 95% CI, 1.52-2.52;P < .001[absolute rates not provided]).78,81”

    From Diabetic Foot Ulcers (2023) · cites this paper as [78]

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Cites

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1 of the 64 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [1]Margolis DJ, Malay DS, Hoffstad OJ, Leonard CE, MaCurdy T, de Nava Karla López, Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008: Data Points #2. Data Points Publication Series Rockville (MD); 2011. 22049565
  2. [42]McGill MN, Constantino M, Bolton T, Palmer E, Yue D. Diabetes Amputation Program: a structured systematic approach. Diabetic Foot Journal 2003; 6: 172– 6.

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Authors
Musuuza, J., Sutherland, B. L., Kurter, S., Balasubramanian, P., Bartels, C. M., & Brennan, M. B.
Affiliations
  • University of Wisconsin–Madison (US)
  • William S. Middleton Memorial Veterans Hospital (US)
Corresponding author
Brennan, Meghan B.
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2020-04
Volume
71
Issue
4
Pages
1433-1446.e3
ISSN
0741-5214 (ISSN-L)
OpenAlex
W2982505295
Cited by
274
References
64
Citations by year
2026: 40 · 2025: 56 · 2024: 48 · 2023: 56 · 2022: 34 · 2021: 27 · 2020: 13
FWCI
2.85
Type
journal article
Language
en
Open access
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
diabetic foot ulcer, multidisciplinary team, major amputation, amputation prevention, team composition, glycemic control, wound care, vascular disease, infection, care algorithm, referral pathways, SEIPS model
MeSH terms
Amputation, Surgical, Humans, Patient Care Team, Diabetic Foot, Limb Salvage

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