A Call to Action: Enhancing Patient-Initiated Communication in Diabetic Below-Knee Amputation Cases for Improved Wound Center Outcomes

OBJECTIVE: Patients undergoing below-knee amputation (BKA) for diabetic complications experience heightened anxiety and poor psychosocial outcomes. Though patient-initiated communication (PIC) clarifies uncertainty, it also increases clinical burden. Primary outcomes were PIC incidence within the perioperative period, PIC rationale, and PIC patient characteristics. METHODS: From December 2021 to August 2023, a retrospective review of BKA patients analyzed PIC via phone calls and portal messages ±90 days of surgery. PIC patients were compared with non-PIC patients, with subgroup analysis of preoperative (pre-PIC) and postoperative (post-PIC) communication. RESULTS: Of 151 BKA patients, 110 (72.8%) initiated 368 PIC encounters. Patients were predominantly male (68.2%), with a mean age of 57.8±13.8 years and a Charlson Comorbidity Index of 4.9±2.9. Pre-PIC (52.2%) was slightly more common than post-PIC (47.8%). PICs addressed administrative issues (37.2%), wound care (17.6%), and medications (19.3%). PIC patients were more likely to be discharged to rehabilitation or home ( P =.046), had shorter length of stay (LOS) [16 (10) vs. 18.5 (15) days, P =.0086], and returned to the operating room (ROR) within 30 days for complications ( P =.037). Multivariate analysis found discharge to home (OR: 6.00, P =.025) and ROR (OR: 0.256, P =.012) independently predicted PIC. Pre-PIC patients were more often married ( P =.038) and discharged home ( P =.045). Post-PIC patients had longer LOS ( P =.005) and fewer RORs ( P =.006). CONCLUSIONS: Identifying high-risk groups and PIC rationale will improve the authors’ institution’s ability to address patient concerns.