Results of Policy Change in Operative Treatment of Infected Diabetic Foot Ulcer
2Medical Corps, IDF, Israel
Background:
Management of a diabetic foot ulcer (DFU) frequently requires an amputation at the bottom of the clinical flowchart. Rate of major to minor amputations differs as a consection of the local healthcare system and population characteristics.
This study evaluated the short and middle-term results of operative treatment policy change in our institution. The policy of 2019-2020 included improved continuity of care with daily wound care by a surgeon, frequent debridement and minor amputations as opposed to the previous approach that favored early major amputations.
Materials and Methods:
Our study retrospectively surveyed medical charts of 290 cases with DFU that underwent an amputation of lower limb and compared their demographics, comorbidities, total number and extent of amputations, rate of major to minor amputations, mortality, percentage of prosthesis fitment, Wagner score, previous amputations, sum of hospitalization days, waiting days to operating theatre, total surgery time, anesthesia type, vascular surgeon involvement and lab values upon admittance.
Results:
We found a statistically significant difference, less major amputations were performed during 2019-2020 compared to 2017-2018. Also, the rate of major to minor amputations has inverted. There was no difference in demographic or clinical data, mortality, prosthesis fitment, waiting and total hospitalization days. Laboratory values upon admittance were correlated to extent of surgery, but with wide standard deviation.
Conclusions:
Our treatment policy changes proved to be effective in preventing major amputations. Lack of difference in prosthesis fitment and high mortality point that on average, our study population suffers from multiple comorbidities, has low ADL function and short life expectancy. Therefore, the importance of limb length preservation for ADL is crucial. Also, our results suggest a future potential of reducing costs of hospitalization, prosthetics and rehabilitation by concentration of DFU patients in one ward and optimisation of ambulatory services.