{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T18:39:06Z","timestamp":1793558346027,"version":"4.5.0"},"reference-count":41,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Background.<\/jats:italic>\n                    Diabetic foot osteomyelitis may precede major limb amputations and lengthy hospital admission. These complications impact patients\u2019 morbidity and mortality. Healthcare institutions with dedicated limb-preservation teams realize reduced amputation rates and improved quality of care. This study evaluates the outcomes following the implementation of a rigorous diabetic limb-preservation program at an academic institution.\n                    <jats:italic toggle=\"yes\">Methods.<\/jats:italic>\n                    Patients with diabetes admitted for osteomyelitis occurring below the knee were identified by\n                    <jats:italic toggle=\"yes\">ICD-10<\/jats:italic>\n                    codes and included for retrospective review. The number and type of amputations, bone biopsies, revascularizations, and hospital length of stay (LOS) were evaluated. Outcomes were compared using the high-low (Hi-Lo) amputation ratio for the 24 months preceding and the 24 months after the integration of a diabetic limb-preservation service.\n                    <jats:italic toggle=\"yes\">Results<\/jats:italic>\n                    . The authors identified and included 337 patients admitted for diabetic foot osteomyelitis. In the 24-month period prior to program implementation, 140 patients were evaluated. In the 24-month period after program implementation, 197 patients were evaluated. The overall amputation rate decreased from 67.1% (n\u2009=\u200994) to 59.9% (n\u2009=\u2009118) (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.214). Major limb amputation rates significantly decreased from 32.9% (n\u2009=\u200946) to 12.7% (n\u2009=\u200925) (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.001). Minor amputation rates significantly increased from 34.2% (n\u2009=\u200948) to 47.2% (n\u2009=\u200993) (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.024). The Hi-Lo amputation ratio decreased from 0.96 to 0.27 (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u2009.001). The rate of obtaining bone biopsies increased from 32.1% (n\u2009=\u200945) to 72.1% (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u2009.001). The rate of revascularization increased from 10.7% (n\u2009=\u200915) to 15.2% (n\u2009=\u200930) (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.299). Average hospital LOS decreased significantly from 11.6 days to 9.8 days (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.044).\n                    <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                    . After the implementation of a limb-preservation team, there was a precipitous drop in major limb amputations in favor of minor amputations. The average hospital LOS decreased. These findings demonstrated improved clinical care and outcomes in patients with lower extremity osteomyelitis and reinforce the importance of a diabetic foot-preservation service within healthcare institutions.\n                  <\/jats:p>","DOI":"10.1177\/15347346231169879","type":"journal-article","created":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T03:04:33Z","timestamp":1683601473000},"page":"1179-1187","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["The Impact of Implementing a Diabetic Limb-Preservation Program on Amputation Outcomes at an Academic Institution in a Majority-Minority State"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7578-1129","authenticated-orcid":false,"given":"Eric","family":"Lew","sequence":"first","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel Perryman","family":"Collins","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Marek","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C","family":"Schenck","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin","family":"Richter","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Gallegos","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6034-5084","authenticated-orcid":false,"given":"Leslie","family":"Dunlap","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Murdock","sequence":"additional","affiliation":[{"name":"The University of New Mexico Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis346"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.5.1435"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.06.003"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67698-2"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2016.01.012"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-0651"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007425"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1842-x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0027-9684(15)30973-1"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211481"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.1436"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.08.244"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2299"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.02.008"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.2.248"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.04.010"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.7547\/1000101"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","unstructured":"Alexandrescu V Hubermont G Coessens V et al. Why a multidisciplinary team may represent a key factor for lowering the inferior limb loss rate in diabetic neuro-ischaemic wounds: application in a departmental institution. Acta Chir Belg. 2009;109(6):694\u2010700. doi:10.1080\/00015458.2009.11680519","DOI":"10.1080\/00015458.2009.11680519"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-1159"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-1178"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2015.01.010"},{"key":"e_1_3_3_24_2","unstructured":"Veterans Health Administration VHA amputation system of care. Accessed April 19 2023. https:\/\/www.va.gov\/vhapublications\/ViewPublication.asp?pub_ID=7482"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.7547\/19-137"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2006.09.015"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.08.003"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3280"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1086\/498112"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1086\/597263"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-2108"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1086\/516148"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.3402\/dfa.v4i0.21847"},{"key":"e_1_3_3_34_2","unstructured":"Centers for Disease Control and Prevention (CDC): Age-adjusted hospital discharge rates per 1 000 diabetic population by level of amputation United Staes 1993-2009 2014a. Accessed December 29 2022. http:\/\/www.cdc.gov\/diabetes\/statistics\/lea\/fig3.htm"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-0079"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.7547\/1010093"},{"key":"e_1_3_3_37_2","unstructured":"Accessed November 10 2021. https:\/\/ibis.health.state.nm.us\/indicator\/view\/DiabPrevl.Year.NM_US.html"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-9021"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcws.2008.08.001"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcws.2009.03.003"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2018.12.002"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2014.12.022"}],"container-title":["The International Journal of Lower Extremity Wounds"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346231169879","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15347346231169879","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346231169879","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:05:38Z","timestamp":1777457138000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15347346231169879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,9]]},"references-count":41,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1177\/15347346231169879"],"URL":"https:\/\/doi.org\/10.1177\/15347346231169879","relation":{},"ISSN":["1534-7346","1552-6941"],"issn-type":[{"value":"1534-7346","type":"print"},{"value":"1552-6941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,9]]}}}