2372. Multidisciplinary Care Teams to Reduce Major Amputations for Patients With Diabetic Foot Ulcers: A Systematic Review

Abstract

BackgroundApproximately 2 million Americans develop a diabetic foot ulcer (DFU) annually; >50% die and 5% lose a limb within 5 years. IDSA guidelines recommend multidisciplinary team care for these patients (moderate evidence). Little is known about who should compose the team or how the team should function (low evidence). We conducted a systematic review following PRISMA guidelines to evaluate the effect of multidisciplinary team care on major amputation in patients with DFU’s and describe team composition and function.MethodsA medical reference librarian searched databases without date limits through May 26, 2017. Two independent reviewers screened abstracts and then full text using the following inclusion criteria: original article; reported the effect of multidisciplinary teams (≥2 specialties) on major amputation; included a control group; >50% of study patients had diabetes; in English. Abstracted data included study design, patient characteristics, team composition and function, and major amputation rates.ResultsWe included 33 studies (Figure 1). Five (15%) were in the United States, and 27 (82%) were historically controlled trials. Thirty-two (97%) documented lower major amputation rates among patients cared for by a multidisciplinary team (Figure 2). Relative reductions ranged from 11 to 90%. A 12% relative increase was observed in the single study documenting increased rates of major amputation following multidisciplinary care. Thirty-six different specialties were represented in the 26 studies reporting team composition, including: endocrinology (85%), vascular surgery (73%), orthopedic surgery (65%), podiatry (54%), and infectious disease (50%). Teams functioned in the following settings: inpatient (30%), outpatient (15%), or both (55%). Among 12 studies reporting team function, the following topics were addressed: surgical debridement/offloading (66%), vascular disease (63%), infection (59%), and glycemic control (41%).ConclusionCare by multidisciplinary teams may help prevent major amputation for patients with DFUs. Team composition and function, and reductions in major amputation rates, varied considerably. Research directly comparing different models of multidisciplinary care is needed. Open in a separate window Open in a separate window Disclosures All authors: No reported disclosures.