University Hospitals plans to make the Dodero Center a national destination for limb preservation for patients with peripheral artery disease and diabetes.
Dr. Shishehbor has dedicated much of his career to limb preservation, serving as principal investigator on a LimFlow therapy clinical trial that found the treatment saved 76% of patients from amputation. The technology received FDA approval based on the trial’s results, according to a Feb. 10 news release from the health system.
He recently shared with Becker’s why establishing the new center was a top priority and what he sees for the future of limb preservation at University Hospitals.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Can you explain a bit more about “why” the limb preservation center has been established?
Dr. Mehdi Shishehbor: We have been committed to limb preservation, and taking care of patients with diabetes and vascular disease at risk of amputation for many years at University Hospitals.
We have learned that these patients are very complex. Not only do they have a significant number of comorbidities, they also face a lot of social challenges. A significant portion of our patients who are at risk of amputation come from underserved populations. They have financial challenges, difficulties making their appointments, and difficulty navigating the care continuum necessary to treat their condition.
We realized taking care of these patients who have a complex chronic disease requires a comprehensive team.
I’ve had a dream for over 25 years to create a limb preservation center. My dream has been to offer comprehensive care for these patients through a multidisciplinary team of vascular surgeons, interventional cardiologists, podiatrists, wound-care experts, nurse coordinators, social services, nutritionists and others, who can take care of these patients as a whole. Working collectively we can get to the goal post, which is healing the wounds, preserving their limbs and preventing amputation.
Once these patients get amputated, they have a 50% chance of death within two years, not to mention the psychosocial and emotional impact of losing a limb. Additionally, the cost of care for these patients is tremendous. Taking care of patients at risk of amputation, or those who undergo amputation, is also very expensive for the healthcare system. The 90-day readmission rate for patients with ulcers and vascular disease is 45%. That means that at 90 days, almost half of these patients are readmitted to the hospital because of their condition.
These are very complex patients with a lot of needs and, unfortunately, health systems are not currently positioned in a way to take care of this complex disease process. We need centers like this, centers that can provide interventions, reduce the burden of the disease and improve the care of these patients.
Q: What clinical outcomes do you expect to see in response to the new center?
MS: We are anticipating that there will be at least a 20% reduction in the rates of amputation. More importantly, our goal and the outcomes that we’re going to be looking at are how well we manage patients’ comorbidities — cholesterol, smoking cessation, control of their chronic kidney disease and others.
We are also interested in addressing the readmission rate for these patients. We are hoping to reduce the readmission rate by at least 15% to 20%.
Q: What are the biggest challenges involved in addressing limb preservation?
MS: Awareness is important on both the patient side and the physician side. On the patient side, a significant portion of these patients come from a disadvantaged background. They may not fully understand the complexity of their condition until it’s too late.
The second part of patient awareness is encouraging them to seek a second or third opinion before amputation. A lot of our patients don’t do this because they believe it is a natural part of having diabetes and vascular disease.
Raising awareness of limb-saving new procedures and techniques among physicians is also very important.
When dealing with complex diseases like these, where patients are at risk of dying or losing a limb, you need a number of experts involved. It is really not safe to have just one or two individuals making a decision about someone’s limb or life.
We are addressing that issue by creating multidisciplinary teams. But from a standpoint of time, commitment and getting different specialists to agree on a multidisciplinary assessment of a patient, it is not easy. It has probably been the biggest challenge.
Q: Where are some of the biggest opportunities for growth now that the limb preservation center has been established?
MS: We believe that this center is going to revolutionize the care of patients at risk of amputation. The way we envision accomplishing this is by focusing on four buckets, if you will.
First, we are going to continue to invest in innovation and research. We believe there are opportunities through stem cells, other biologics and other technical approaches that will allow us to help even more of these patients — not only in northeast Ohio, but nationally and internationally.
Second, we want to invest in education, making sure both physicians and patients understand there are many opportunities to do more for these patients and save their limbs.
The third bucket is bringing value-based care to these patients. When you provide care coordination for these patients you’re going to reduce readmission rates and length of stay. You’re going to help them heal their wounds faster, and they’re going to become more effective members of society. They’ll be able to go back to work, function better and reduce depression and other consequences of having an ulcer or gangrene. There are huge opportunities in terms of improving the quality of care. Providing value-based care to these patients will not only generate significant savings for the organization but also improve patient quality of life.
And lastly, we are obligated to continue educating internationally. We are working on building an international symposium that will bring together the most advanced experts in the field of chronic limb-threatening ischemia and limb salvage. We will bring physicians and other experts here to Cleveland to share best practices and innovative ideas — both from us to them and from them to us — so that we can elevate the care of these patients globally.
