Introduction
For patients suffering from ischemic and diabetic wounds, a multidisciplinary approach to care is crucial. Outpatient Wound Care centers play a vital role in this approach, offering structured and continuous care, especially after procedures like revascularization or hospital stays. These centers facilitate the integration of various medical specialties, aiming to improve patient outcomes. This article examines the changes in treatment patterns and patient results following the establishment of an outpatient wound care center affiliated with a tertiary vascular surgery practice.
Methods
A prospective study was conducted using an institutional database to compare patient outcomes before and after the opening of an affiliated outpatient wound care center. The study included patients who underwent lower-extremity revascularization, amputation, or surgical debridement. Data was collected over two consecutive 3-year periods: before the wound care center (BWC) and after the wound care center (AWC). Patients included in the analysis had interventions for atherosclerotic peripheral arterial disease or diabetic foot ulcers (DFUs). The study assessed shifts in the number of cases, reasons for surgery, and types of procedures performed. The primary clinical outcomes measured were the rates of lower-extremity amputations and overall mortality.
Key Findings
The study analyzed data from 1751 procedures performed on 1249 limbs. A significant shift in the focus of the vascular service was observed after the wound care center opened. Limb salvage procedures became a more significant part of the total cases, increasing from 19% to 26% (P < .0001). Overall, the volume of lower-extremity interventions saw a substantial increase of 64%, rising from 662 procedures in the BWC period to 1085 in the AWC period. While the types of revascularization procedures remained consistent across both periods, there was a notable increase in surgical debridements (from 8.9% to 13%; P = .01) and infrapopliteal endovascular interventions (from 21% to 28%; P = .04). Furthermore, patients in the AWC period were more likely to present with diabetic foot ulcers (7.3% vs 13%; P = .002) and chronic wounds (39% vs 45%; P = .05). Critically, at the one-year follow-up mark, major amputation rates were significantly lower in the AWC group compared to the BWC group (5.5% vs 8.8%; P = .04). Treatment during the AWC period was linked to a reduced risk of major amputation (adjusted hazard ratio, 0.41; 95% confidence interval, 0.27-0.62; P < .001). However, no significant difference in all-cause mortality was observed between the two groups.
The Synergistic Role of Wound Care Centers
These findings underscore the positive impact of integrating outpatient wound care centers with vascular surgery practices. The increased volume of limb salvage procedures and the decrease in major amputation rates suggest that wound care centers facilitate more proactive and effective management of complex wounds. By providing a dedicated setting for multidisciplinary care and consistent follow-up, these centers likely enable earlier intervention and better coordination of treatments. The rise in debridement and infrapopliteal interventions further suggests a more aggressive approach to limb preservation in the AWC period. This synergistic system, where vascular surgeons are integral to wound care centers, appears to be a key factor in improving outcomes for patients with severe lower extremity wounds.
Conclusion
The establishment of an outpatient wound care center in conjunction with a tertiary vascular surgical practice is associated with a higher number of patients undergoing limb salvage procedures and an overall increase in related interventions. Most importantly, the risk of major amputation was significantly reduced after the wound care center became operational. This study highlights the potential benefits of integrating vascular surgeons into outpatient wound care centers to create a synergistic system that promotes more effective and aggressive strategies for limb salvage, ultimately leading to improved patient outcomes in wound care.
