Analysis of quality of ambulatory follow-up of patients with type 2 diabetes mellitus after reconstructive operations on the aortoiliac segment

Doguzhieva R.M, Pokrovskii A.V., Bogatov Yu.P., Demidova V.S., Lebedeva A.N., Titova M.I., Goltsova E.A.

Department of Vascular Surgery A. V. Vishnevsky Institute of Surgery under the Russian Federal Agency on High-Technology Medical Care, Moscow, Russia

The article is dedicated to assessment of quality of ambulatory management of patients suffering from type 2 diabetes mellitus in remote terms following reconstructive operations on the aortoiliac segment. The aspects investigated included the frequency of the of patients’ visiting the district polyclinic, as well as frequency and quality of planned examinations and conservative treatment. Presented herein are the results of questioning and comprehensive examination of fifty-six patients suffering from type 2 diabetes mellitus (mean age 62.3±1.7 years) performed averagely 61.9±2.1 months after surgical treatment. Fifty percent of these patients appeared to have prior to the operation had critical ischaemia of the lower extremities. By the time of the check up examination, 62.5% of these preserved stage 1 or 2A ischaemia and 37.5% had stage 2B ischaemia, which on the whole was indicative of a long-term positive outcome of surgical interventions in this severely ill cohort of patients. During this time period, in 23 (41.1%) patients with baseline critical ischaemia it turned out possible to avoid limb amputation, and 62.5% were found to have considerably increased the distance of pain-free walking (stage 1 or 2A). Together with it, the obtained findings suggested virtually total lack of adequate angiological care for the postoperative patients at the ambulatory-polyclinic level. First of all, there are neither correctly organized dispensary follow up of patients nor continuity between the clinical hospital and the polyclinic. Analysing the check-up clinical evidence showed that 83.9% of patients required correction of blood glucose level, 96.4% that of lipid profile, and 73.2% that of the haemocoagulation system. Twenty-five (44.6%) patients required stagewise reconstructions due to an atherosclerotic lesion of the previously intact arteries of the lower limbs (21), prosthesis-leg thrombosis (1) and anastomotic restenosis (3).

Hence, the clinical effect of a clinical intervention in diabetic patients is apparently evident. Correct and adequate organization of therapeutic and preventive care at the ambulatory and polyclinic level may substantially improve the remote results of vascular operations in this cohort of patients.

KEY WORDS: type 2 diabetes mellitus, reconstructive operation, aortoiliac segment, postoperative period, dispensary follow-up, polyclinic.

P. 24-25

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