Predictors of operative management in diabetic foot ulcers

Author:

Au Amos1ORCID,Yii Erwin2,Andric Ana3,Wong Jennifer4,Saunder Alan15,Yii Ming15

Affiliation:

1. Department of Vascular Surgery Monash Health Clayton Victoria Australia

2. Department of Vascular Surgery Eastern Health Box Hill Victoria Australia

3. Department of Podiatry Monash Health Clayton Victoria Australia

4. Department of Endocrinology Monash Health Clayton Victoria Australia

5. Department of Surgery School of Clinical Sciences at Monash Health Monash University Clayton Victoria Australia

Abstract

AbstractBackground & AimsSurgery plays a key role in the management of complicated diabetic foot disease (DFD). Currently, indications for medical versus surgical management are poorly defined. Prompt identification of patients who require surgery may reduce morbidities and length of hospital stay. This study aims to analyse factors in DFD that necessitate early surgical interventions.MethodsAll patients admitted under a multi‐disciplinary diabetic foot team in a tertiary institution over 2 years were included in a retrospective case‐control study comparing patients who received medical management and patients who received surgical management. Logistic regression was performed to identify factors associated with surgical management of diabetic foot complications.ResultsThree hundred and forty patients were included. 49% of patients required surgical management. Toe ulceration, elevated C‐reactive protein (CRP), and the presence of osteomyelitis were associated with surgical management. Multivariate analysis calculated an odds ratio (OR) of 1.01 for CRP (p < 0.001), OR 2.19 (p < 0.019) favouring surgical management for forefoot ulcers, and OR 2.2 (p < 0.019) if osteomyelitis was present.ConclusionsPatients with elevated CRP levels, a forefoot diabetic ulcer and established osteomyelitis were more likely to undergo surgical management. Prompt recognition of these patients has the potential benefit of earlier decision making in definitive surgical interventions.

Publisher

Wiley

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