BENCHMARK ANALYSIS ON DIABETICS AT HIGH-RISK FOR LOWER-EXTREMITY AMPUTATION

After the 1990 establishment of a multidisciplinary foot salvage clini c, 1346 diabetic patients, at high risk for the development of foot ul cers and eventual lower limb amputation, were followed for 4 years. Of the 224 high-risk patients admitted to the hospital, 74 amputations ( 5.5%) of all or part of a lower limb were performed. Patients undergoi ng amputation were younger, more severely ill, and required more frequ ent hospitalizations because of greater organ system involvement. They were also more likely to be institutionalized after discharge. Overal l, patients with long-standing adult-onset diabetes, identified as at high risk for foot ulcer development, have a substantially increased r isk for lower limb amputation, multiple organ system failure, hospital ization, and institutionalization than do diabetic patients as a whole . Clinical benchmarking facilitates the identification and reduction o f unnecessary variations in patient care practices. Here, a formal ben chmark analysis provides the current outcome expectations for amputati on rates and co-morbidities in patients with diabetes who are classifi ed as at high risk for lower extremity amputation. Management of these patients in a structured, multidisciplinary foot salvage clinic, augm entation of baseline services, and preliminary benchmark data may prov ide a standard for the measurement of therapeutic interventions that i mprove patient care.