Wound healing outcomes in a diabetic foot ulcer outpatient clinic at an acute care hospital: a retrospective study
Abstract
Objective: Patients with diabetic foot ulcers (DFU) have an increased risk of lower extremity amputation. A retrospective chart review of patients with DFUs attending the Foot Treatment and Assessment chiropodistled outpatient clinic at an inner-city academic hospital was conducted to determine wound healing outcomes and characteristics contributing to outcomes.
Method: We reviewed the complete clinical history of 279 patients with 332 DFUs spanning over a five-year period.
Results: The mean age of patients was 61.5±12.5 years and most patients (83.5%) had one DFU. The majority of wounds (82.5%) were in the forefoot. Overall, 267/332 (80.5%) wounds healed. A greater proportion of wounds healed in the forefoot (82.5%) and midfoot (87.1%) than hindfoot (51.9%; p<0.001). Using a logistic regression model, palpable pedal pulse and use of a total contact cast were associated with better wound healing.
Conclusion: Our findings are the first to demonstrate the benefits of chiropodists leading an acute care outpatient clinic in the management of DFUs in Canada and delivers wound healing outcomes equivalent to or exceeding those previously published.
More than two million Canadians have diabetes, and that number is projected to grow to 3.7 million by 2019.1 Diabetes is reaching epidemic proportions, with a concomitant increase in complications associated with the disease, such as diabetic foot ulcers (DFUs) and lower extremity amputations. An estimated 15% of people with diabetes will develop a DFU in their lifetime, and it is a common cause of hospital admission.2 People with diabetes have an increased risk (x15) of lower extremity amputation.3 However, up to 80% of major and 70% of minor amputations can be prevented by screening and appropriate management.4 The treatment of DFUs is complex due to the multifactorial nature of their aetiology. Thus, the assessment and management of DFUs require careful and timely orchestration of clinical triage, local wound care factors, appropriate offloading of the ulcer area, and consideration of various patient factors. A team approach for acute management is purported to prevent the rapid progression to lower extremity amputations.5
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