Presence of outpatient wound care center leads to significant decrease in amputation rates, says Stanford specialist

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Venita Chandra

NEW YORK—The opening of an outpatient wound care center has a positive impact on affiliated vascular surgery practice, with a significant increase in the number of peripheral interventions and a significant decrease in amputation rates, attendees of the 2019 VEITHsymposium (Nov. 19–23) were told during a session on issues related to vascular outpatient centers, office-based labs and medical ethics.

In addition, Venita Chandra, MD, clinical associate professor of vascular surgery at Stanford University School of Medicine, Stanford, California, outlined several other potentially positive impacts: lower length of stay, and lower mortality, complication and readmission rates. She was giving a talk highlighting the advantages to a vascular surgery practice of having a wound care center.

These conclusions are derived from a study carried out by Chandra et al into a now six-year-old wound care center opened at her institution that analyzed data from three years before its doors swung open and three years afterward.

Setting the scene, she drew attention to the scale of the problem at hand: “The incredibly large number of non-healing chronic wounds has a huge impact in not just United States costs in healthcare but worldwide,” Chandra said.

By way of example, she made reference to those patients whose limbs are under threat as “perhaps the most complicated and complex that you deal with and require all of our resources. Many experts in our division and within our field come up with

strategies to help reduce the risk of amputation and help those complex patients. Almost all of them involve multidisciplinary teams and are shown to significantly decrease amputation rates. Wound care, however, with standardized weekly debridement and management of offloading and edema, has clearly been shown to be a key aspect of that multidisciplinary [approach].”

The payoff may lurk down the road with potential downstream revenue impacts in a vascular surgery practice, said Chandra.

The Stanford study produced some interesting findings. “In the cohort after the wound care center opened, we had a 20% overall increase in volume of cases in that period,” Chandra went on. “However, if you specifically look at the percentage of lower extremity interventions, the increase was 64%, a statistically significant increase.”

She continued: “Not surprisingly, over this period of time we had an increasing number of patients treated for diabetic foot ulcers and incidentally a decrease in the relative percentage of patients treated for claudication. We essentially started treating critical limb ischemia more often.”

In terms of outcomes, the institution’s minor amputation rate went up while its one-year amputation rate went down.

“When we did multivariable analysis, adjusting for demographics and co-morbidities and indications, you can see there remains a statistically significant impact of the opening of a wound care center on our amputation rates,” Chandra explained.

The data also yielded intriguing findings on referral patterns, she said. “What we found was actually only 35% of the patients started in the wound care center came to the vascular surgery practice, and actually 65% seen first in the vascular surgery practice [were] sent to the wound care center.”

Chandra then turned to findings not covered specifically by the study. Comparing Stanford to other academic hospitals in California, she said “we have one of the lowest lengths of stay and the lowest 30-day readmission rate for patients who are being treated for lower- extremity revascularizations.”

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