Organization of wound healing services: The impact on lowering the XXXX foot amputation rate in a ten-year review and the importance of early debridement.

@entity1 @entity25697 @entity6 @entity3918 @entity4760
@entity4760 ( @entity4760 ) has a negative impact on the quality of life and leads to disabling morbidity, such as lower extremity amputation (LEA). This study aimed to evaluate the LEA trend before and after the establishment of the @entity6 foot team, an on-time debridement, on-site screening, and multidisciplinary integration with standardizing care, in Chang Gung Memorial Hospital, @entity25697 Yi, Taiwan, starting in 2010. The study retrospectively investigated the non-traumatic LEA rate in @entity6 foot (identified by using ICD-9-Clinical Modification (CM) codes, 250.70-250.83) and whole @entity1 with @entity6 (ICD-9 250.XX) yearly from 2004 to 2013. @entity1 were enrolled from hospitalization, emergency room (ER), or outpatient departments, respectively. Despite the overall incidence of @entity6 foot in @entity1 with @entity6 remaining constant, from 3.47% in 2004 to 3.58% in 2013, the incidence of hospitalized @entity6 foot from @entity6 reduced, from 2.83% in 2004 to 1.51% in 2013. Introduction of integrated wound care also led to a reduction of the average LEA rate in hospitalized @entity1 , from 15.27% (2004-2009) to 6.08% (2010-2013) (P<0.001). A similar decline of the LEA rate was observed for @entity1 from hospitalization, ER and outpatient departments together with an average LEA rate from 7.99% (2004-2009) down to 3.02% (2010-2013) (P<0.001). In trend analysis, the curve estimation revealed a quadratic trend in the relationship between LEA rate and time (R-square=0.869, P=0.001) for hospitalized @entity1 as well as a linear (R-square=0.819, P<0.001) and quadratic (R-square=0.845, P=0.001) trend in the relationship between LEA rate and time for hospitalization, ER, and outpatient departments together. The LEA rate for @entity3918 @entity1 declined from 372.72/100,000 in 2004 to 61.74/100,000 in 2013. With establishment of an organizing, standardized wound care protocol and integrated multidisciplinary team, we demonstrated a significant decline in the LEA rate both in @entity6 foot @entity1 and all @entity1 with @entity6 . These improvements can be attributed to introducing an efficient pathway with on-time debridement and early intervention of @entity4760 .
