Abstract
Introduction
The need for multidisciplinary care of patients with advanced limb threat is well
established. We examined patient reported outcomes and health-related quality of life
(HR-QoL) for those who completed a multidisciplinary extremity preservation program
(EPP) at our institution.
Methods
Patients with advanced limb threat, who had previously failed standard management
at a tertiary-care center, were referred to EPP for evaluation by a multidisciplinary
panel of vascular, plastic, orthopedic and podiatric surgeons, along with infectious
disease, prosthetics, orthotics, imaging, palliative care, social work and wound nursing
specialists. HR-QoL was quantified before and after EPP participation with the RAND-36
questionnaire. The validated RAND-36 assesses physical function, role limitations
caused by physical and emotional health problems, social functioning, emotional well-being,
energy, pain and general health perceptions.
Results
From 2018 to 2020, 185 patients were referred to EPP. After review by the multidisciplinary
panel, 120 were accepted into the program, 63 of whom completed their course of care;
9 were one-time consultations. The median number of EPP in-person care visits was
23 (13-54) per participant; 87.3% of patients received one or more surgical procedure,
including operative debridement (73%), revascularization (44%), soft tissue reconstruction
or transplantation (46%), as well as hyperbaric oxygen therapy (11%) during their
course of treatment.
85.7% of patients achieved complete wound healing, 41.5% occurring within 6 months.
Ultimately, 14.3% required a major amputation. Graduates noted improvement in all
categories of the HR-QoL upon completion, including those undergoing major amputation.
On adjusted multivariate regression analysis, patients with immunocompromised status
were more likely to show greater improvement in their social function (OR: 10.1; P<0.044)
and emotional role limitation (OR:8.1; P=0.042), while patients with larger wound
volume at presentation were more likely to have greater improvement in their general
health (OR: 1.1; P<0.049). Conversely, patients with a smoking history had less improvement
in energy level (OR:0.4; P=0.044) and patients with dialysis-dependence had less improvement
in social function (OR:0.2; P=0.034).
Conclusion
Coordinated, multidisciplinary extremity preservation program improves HR-QoL of patients
with complex limb threat, including those who are immunocompromised with impaired
social function and emotional role limitations. Further study is warranted to better
characterize the generalizability of this approach, including considerations of cost-effectiveness,
wound recidivism, and limiting the number of in-person visits required to achieve
complete healing.
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Article Info
Publication History
Accepted:
May 23,
2022
Received in revised form:
May 14,
2022
Received:
April 3,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosure: The authors have no financial disclosures.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
