New concepts for interdisciplinary care of patients with neuroischemic diabetic foot syndrome. Disease management, integrated care, case management

Most amputations in Germany (ca. 70%) are performed on patients with diabetes mellitus. The main cause is diabetic foot syndrome (DFS), which leads to 40,000 amputations annually, whereby half of the amputations are performed above the ankle. The amputation rate in diabetics could be reduced by 80% using revascularization (e.g., bypass surgery, if needed in combination with a minor amputation and debridement). Revascularization does not, however, solve the complex problems of these patients. The recovery period is often very long, and due to insufficient communication, out-patient follow-up is often difficult due to the high complexity of the case, financial and cost pressures, and the complex postoperative complication and wound management. Approximately 50% of patients with critical ischemia will be treated again as inpatients within 6 months. If the patient is again admitted within the general maximum length of stay of the case lump sum with the same diagnosis, the lengths of stay will be added together. This characteristic of the German DRG system forces hospitals to provide follow-up treatment without adequate reimbursement. Improvement in the prognosis can be achieved using a structured interdisciplinary approach with specialized in- and outpatient treatment facilities. Further improvement can be achieved by integrating these centers into regional networks.