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

Publication/Presentation Date

2-10-2026

Abstract

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.

ISSN

1538-8654

Disciplines

Medicine and Health Sciences

PubMedID

41666358

Department(s)

Medical Education

Document Type

Article

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