Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study

Choi, Sang Kyu; Kim, Cheol Keun; Jo, Dong In; Lee, Myung Chul; Kim, Jee Nam; Choi, Hyun Gon; Shin, Dong Hyeok; Kim, Soon Heum

doi:10.5999/aps.2017.01207

Cited by 20 publications

(14 citation statements)

References 26 publications

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“…In addition, once accumulated, uremic toxins lead to phagocytic dysfunction. Therefore, these patients are disposed to developing impaired infection control (Choi et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

Ezeani¹,

Ugwu

Adeleye

et al. 2020

Endocrine Regulations

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Objective. The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU.Methods. The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing.Results. The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004–0.332). This was followed by PAD (OR 0.093; 95% CI 0.028–0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030–0.395), anemia (OR 0.179; 95% CI 0.056–0.571).Conclusion. Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.

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“…In addition, once accumulated, uremic toxins lead to phagocytic dysfunction. Therefore, these patients are disposed to developing impaired infection control (Choi et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

Ezeani¹,

Ugwu

Adeleye

et al. 2020

Endocrine Regulations

View full text Add to dashboard Cite

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“…17 The other study about length of hospital stay in diabetic foot found that WBC count, CRP levels, and albumin levels were strongly correlated with long term hospital stay. 18 Furthermore, poor prognosis predictors decremental albumin levels and incremental HbA1c are strongly related with elevated plasma protein glycation that irreversibly impairs the wound healing physiology from cells-to-organs. Also wound healing mechanisms; as migration, proliferation, and transdifferentiation steps are affected due to the toxic effects of impaired blood glucose control.…”

Section: Discussionmentioning

confidence: 99%

Analysis of routine blood markers for predicting amputation/re‐amputation risk in diabetic foot

Gülcü

Etli

Karahan

et al. 2020

International Wound Journal

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Diabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re‐amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee‐disarticulation, above‐knee amputation) and re‐amputations recorded and compared with routine blood parameters. Re‐amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re‐amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re‐amputation. The statistically optimal HbA1c cutoff point for diabetes was ≥7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re‐amputation possibility.

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“…These are factors that commonly affect the physiological reserve of the patients. Co-morbidities, malnutrition, anemia among others are usually considered to play a role in such patients [ 7 ]. The patients enrolled in the study therefore all had normal serum albumin, adequate hematocrit and normal sugar levels.…”

Section: Introductionmentioning

confidence: 99%

Comparing hospital stay and patient satisfaction in a resource poor setting using conventional and locally adapted negative pressure wound dressing methods in management of leg ulcers with split skin grafts: a comparative prospective study

Maduba¹,

Nnadozie²,

Modekwe³

et al. 2020

PAMJ

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Introduction chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing. Methods sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5 th post-operative day and were determined with planimeter grid. Grafts were monitored until completely healed and patients were discharged. Satisfaction and length of stay were determined at discharge. Results the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome. Conclusion negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks.

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Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study

Cited by 20 publications

References 26 publications

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

Analysis of routine blood markers for predicting amputation/re‐amputation risk in diabetic foot

Comparing hospital stay and patient satisfaction in a resource poor setting using conventional and locally adapted negative pressure wound dressing methods in management of leg ulcers with split skin grafts: a comparative prospective study

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