Podiatrists Decrease the Odds of Major Amputation in Patients with Diabetes and/or Peripheral Arterial Disease in All Practice Settings: A Retrospective Administrative Claims Data Analysis

Background: /Objectives: The management of diabetic foot ulcers and/or peripheral arterial disease requires an interdisciplinary approach. Little has been written to demonstrate the effect of podiatry in non-academic settings. To demonstrate the impact of podiatrist on major non-traumatic lower extremity amputations (NTLEA) among patients with type 2 diabetes with foot ulcer and/or Peripheral arterial disease (PAD) using national administrative data. Methods: A retrospective cohort study using administrative data from all U.S states and territories between 2010 to 2022 to examine odds for major amputation (i.e., above-ankle) with and without podiatry. Interdisciplinary approach was defined as any surgical services performing major NTLEA in addition to podiatry care. Multivariable regression models were conducted to assess the primary outcome while controlling for age, gender, Charlson Comorbidity Index, obesity, tobacco use, chronic kidney disease, peripheral neuropathy, heart disease, presence of an ulcer, and presence of PAD. Results: Overall, 2% of the population experienced a major NTLEA (n=5,493). Adjusted odds of vascular and general surgeons performing major amputation were 3.82 (97.5% CI [3.61-4.06]) and 2.59 (97.5% CI [2.42-2.77]), respectively. Adjusted odds decreased to 1.38 (97.5% CI [1.21-1.57]) and 1.10 (97.5% CI [0.90-1.33]), respectively, when podiatry was involved in the care. Conclusions: Regardless practice settings, including podiatry with other surgical providers as part of the interdisciplinary approach for amputation prevention reduces the odds of major non-traumatic lower extremity amputation.