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When
Arlene Wilbert of Burlington, VT, developed diabetes-related complications
in her leg that multiple surgeries failed to cure, local doctors
told her they would have to amputate. “I was scared to death,” Wilbert
remembers. Fortunately her daughter found Frank LoGerfo, M.D., BIDMC’s
chief of vascular surgery, on the Internet. “Arlene refused to give
up on saving her leg,” LoGerfo recalls. “She was right. Often we
can do something that makes a difference.” LoGerfo performed a bypass
with vein graft on Wilbert’s leg, then a skin graft. During her
two-week hospital stay, Wilbert notes, LoGerfo frequently stopped
in to check on her. These days Wilbert walks painlessly with a cane,
both legs intact. “Dr. LoGerfo’s the most precious thing — always
a big smile, making you feel confident,” she says. “Your hospital
is wonderful!” Shows Outstanding Outcomes
A ten-year study of
more than 6,500 BIDMC patients has shown a mortality rate of only one
percent among diabetes patients undergoing major vascular operations at
the medical center. The findings, published in the April issue of the
Archives of Surgery and presented at the New England Surgical Society’s
annual meeting, represent the largest study of this type ever to conclude
that patients with diabetes should be offered the same surgical options
as patients without the disease. “These results show mortality rates that are dramatically lower at BIDMC than the national average in patients both with and without diabetes,” says lead author Allen D. Hamdan, M.D., BIDMC vascular surgery, explaining that mortality rates of between four and six percent would typically be expected. He attributes the study’s extremely positive outcomes to a coordinated treatment approach among BIDMC’s vascular surgeons, cardiologists, anesthesiologists and specialized vascular nurses, and Joslin Diabetes Center’s endocrinology experts, resulting in excellent patient care. (See sidebar for one patient’s success story.)
More than 16 million U.S. residents have diabetes mellitus, which puts them at an increased risk of vascular disease in all of the body’s arteries, including the legs and lower extremities. This often can lead to ulceration, and, potentially, amputation. “These study results are especially good news for diabetes patients who might otherwise have to undergo amputation for the removal of limbs,” explains BIDMC’s Frank W. LoGerfo, M.D., chief of vascular surgery. “The findings suggest that these patients would be at low risk for complications in lower extremity revascularization surgery, which is performed to restore circulation to the foot.” Study co-authors included present and former BIDMC vascular surgeons Stephanie S. Saltzberg, M.D., Malachi Sheahan, M.D., James Froehlich, M.D., Cameron M. Akbari, M.D., David R. Campbell, M.D., LoGerfo, and Frank B. Pomposelli, Jr., M.D. The authors used a comprehensive computerized registry created by LoGerfo and BIDMC vascular surgeons Pomposelli and Campbell to review more than 6,500 major vascular procedures performed between January 1990 and May 2000. The registry database, which remains in existence, thoroughly documents the outcomes of every BIDMC vascular surgery patient, as well as patient demographics and preoperative risk factors. The authors used statistical methods to look for independent risk factors that might predict an increase in morbidity and mortality during hospitalization for surgery — hypertension, coronary artery disease, renal failure and smoking, in addition to diabetes. Their results showed that diabetes alone did not pose an added risk for patients. “These findings offer diabetes patients an important option when it comes to their health care,” says Hamdan. “There is no reason to expect anything but excellent results in these vascular procedures.”
-Bonnie Prescott
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