Research identifies predictors of surgical management in diabetic foot ulcers

Toe ulceration, elevated C-reactive protein, and the presence of osteomyelitis were associated with the surgical management of complicated diabetic foot disease, new research has identified.

While surgery plays a vital role in the treatment of diabetic foot disease (DFD), the criteria for medical versus surgical management is currently not well defined.

An Australian research team analysed the factors in DFD that trigger early surgical treatment, saying that identifying these factors and the patients who need surgery could reduce morbidities and the amount of time a patient needs to stay in hospital.

They looked at data from 340 patients over a two-year period, comparing those who underwent surgery – 49 per cent – and those who received medical management.

The team reported: “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.”

They concluded: Patients 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.

“Patients with these three factors would benefit from consideration of early patient-centred interventions with the potential of reducing inpatient stay. Identification of these factors in patients presenting with complicated DFD early in the admission course followed by prompt surgical intervention may reduce morbidities and length of stay and prevent unnecessary delays to care.

“Furthermore, this study will help clinicians in centres that do not have a Diabetic Foot Unit to recognise such patients in order to enable expedient transfers to centres that are best equipped to look after them.”

Read the study in full: Predictors of operative management in diabetic foot ulcers

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