Healing Outcomes in Diabetic Foot Ulcers Managed Within a Structured Multidisciplinary Care Model: A Retrospective Study.
Diabetic foot ulcers (DFU) impose a healthcare burden due to prolonged hospitalization, high amputation rates, and increased mortality. This study evaluated healing outcomes and explored factors associated with adverse outcomes among patients managed within a structured multidisciplinary DFU care setting at a specialized diabetes care center in Kerala.
A retrospective analysis was conducted among 1057 patients with DFUs managed between January and November 2022. Care included wound culture-directed antibiotics, glycemic optimization, offloading, daily debridement and dressing, and vascular assessment when indicated. Healing outcomes were assessed, and factors associated with poor outcomes and delayed healing were evaluated using multivariable logistic regression.
In the full cohort, 74.7% of patients achieved complete healing, whereas the major amputation rate was 2.6%. After excluding referrals, deaths, and loss to follow-up, 887 patients comprised the complete follow-up cohort, of whom 790 (89.1%) achieved favorable outcomes, and 97 (10.9%) experienced poor outcomes (nonhealing ulcer or major amputation). Coronary artery disease (OR 2.08, 95% CI 1.23-3.51; p = 0.006) and prior ulcer history (OR 2.41, 95% CI 1.55-3.74; p < 0.001) were independently associated with poor outcomes. Among patients with healing-time data (n = 766), chronic kidney disease was independently associated with delayed healing (> 5 months) (OR 1.96, 95% CI 1.26-3.06; p = 0.003).
High rates of favorable outcomes and low rates of major amputation were observed in this cohort managed within a multidisciplinary DFU care model. These findings support the need for prospective multicenter evaluations of multidisciplinary DFU care models.
A retrospective analysis was conducted among 1057 patients with DFUs managed between January and November 2022. Care included wound culture-directed antibiotics, glycemic optimization, offloading, daily debridement and dressing, and vascular assessment when indicated. Healing outcomes were assessed, and factors associated with poor outcomes and delayed healing were evaluated using multivariable logistic regression.
In the full cohort, 74.7% of patients achieved complete healing, whereas the major amputation rate was 2.6%. After excluding referrals, deaths, and loss to follow-up, 887 patients comprised the complete follow-up cohort, of whom 790 (89.1%) achieved favorable outcomes, and 97 (10.9%) experienced poor outcomes (nonhealing ulcer or major amputation). Coronary artery disease (OR 2.08, 95% CI 1.23-3.51; p = 0.006) and prior ulcer history (OR 2.41, 95% CI 1.55-3.74; p < 0.001) were independently associated with poor outcomes. Among patients with healing-time data (n = 766), chronic kidney disease was independently associated with delayed healing (> 5 months) (OR 1.96, 95% CI 1.26-3.06; p = 0.003).
High rates of favorable outcomes and low rates of major amputation were observed in this cohort managed within a multidisciplinary DFU care model. These findings support the need for prospective multicenter evaluations of multidisciplinary DFU care models.
Authors
Vijayakumar Vijayakumar, Rahim Rahim, Satheesh Satheesh, Sreehari Sreehari, Aswathi Aswathi, Sreekanth Sreekanth, Revathi Revathi, Vishnu Narayanan Vishnu Narayanan, Gopan Gopan, Jaleel Jaleel
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