Survival and healthcare reimbursements of individuals with lower extremity amputation performed in hospitals with and without a multidisciplinary diabetic foot team: A nationwide study using Dutch reimbursement data (DUDE 12)

INTRODUCTION: To enhance prevention and appropriate treatment of diabetic foot ulcers (DFUs) and lower extremity amputation (LEA), multidisciplinary diabetic foot teams (MDFTs) are promoted. The primary aim of this study was to evaluate outcomes of individuals with diabetes mellitus (DM) who underwent LEA in hospitals with or without MDFT. METHODS: We performed a matched cohort study and case-control study using Dutch nationwide healthcare reimbursement data, including data up to six years after- and three years prior LEA. We created study groups and matched control groups varying in DM status (DM+ or -), LEA status (LEA+ or -) and presence of MDFT (MDFT+ or -) in the year 2016, enabling comparison of survival and healthcare reimbursements. RESULTS: Overall 5-year survival (approximately 40%) and mean total reimbursements in 2016 (approximately €55,000) were comparable for both study groups DM + LEA+MDFT+ and DM + LEA+MDFT-. Survival and reimbursements for study group DM + LEA+ were comparable to control group DM-LEA+ but worse than control group DM + LEA-. Higher reimbursements for status LEA+ were observed years prior to index year. CONCLUSION: In this observational study based on reimbursement data, survival and healthcare reimbursements in individuals with DM who underwent LEA appeared broadly similar between locations with and without MDFT. Prognosis after LEA was poor, underscoring the importance of prevention and potentially improved post-LEA care.