Postoperative healing in the diabetic foot is impacted by discharge destination

Abstract

The aim of this study was to evaluate the impact of discharge destination on diabetes‐related limb salvage surgery outcomes post‐hospitalisation. This was a single‐centre, observational, descriptive study of 175 subjects with diabetes who underwent limb salvage surgery of a minor foot amputation or wide incision and debridement for an acutely infected diabetic foot ulcer (DFU). Comparisons were made between subjects discharged home vs a skilled nursing facility (SNF) for 12 months postoperatively. Univariate, multivariate, and time‐to‐event analyses were performed. The SNF discharge group (n = 40) had worse outcomes with longer healing time (P = .022), more rehospitalisations requiring a podiatry consult (P = .009), increase of subsequent ipsilateral major lower‐extremity amputation (P = .028), and a higher mortality rate (P = .012) within the 12‐month postoperative period. There was no significant difference between the cohorts in surgically cleared osteomyelitis (P = .8434). The Charlson Comorbidity Index values for those discharged home and those in a short‐term nursing facility were similar (P = .3819; home truex¯=5.33 ± 2.84 vs SNF truex¯=5.75 ± 2.06). The planned discharge destination after limb salvage surgery among people with an acutely infected DFU should be an added risk factor for healing outcomes. Patients discharged to SNFs experience additional morbidity and mortality compared with patients discharged home post‐hospitalisation.

Changes in daily nursing needs and self‐care capability of people with diabetes after in‐hospital treatment for foot complications: A descriptive study

“…The median length of stay in hospital in our study was 10 days. This is similar to other studies (Burmeister et al, 2021;Rosi et al, 2021).…”

“…The median length of stay in hospital in our study was 10 days. This is similar to other studies (Burmeister et al., 2021; Rosi et al., 2021). However, it has been shown that length of stay is longer among patients who have had a major amputation compared to those who have been treated with minor amputation or conservatively without surgical intervention (Rosi et al., 2021; Syed et al., 2022).…”

“…Thus, continuous multidisciplinary team care of these patients after discharge is essential to improve the outcome. Care planning optimized to meet patients' physical and nursing needs before discharge is also essential to improve the outcome (Burmeister et al., 2021). Post‐discharge care may involve education of family members as well as community nurses and nurse assistants to provide adequate healthcare and continuous support to these patients and reduce the recurrence of diabetic foot ulcers (Annersten Gershater et al., 2013; Janlov et al., 2006; Wuri Kartika et al., 2021).…”

Factors Predisposing Patients to Non-Home Discharge After Surgery for Degenerative Cervical Myelopathy: A Retrospective Analysis

“…This supports recent literature, which suggests that patients who are discharged to SNF after an operation have increased morbidity and mortality and are more likely to develop infection. [5][6][7] Discharging a patient to an SNF is also more costly than discharge to home health care 4,17 and expenditures increase further when the patients that are discharged to SNF experience complications. In an ideal situation, all patients would be able to go home safely after surgery and would not require the extra care provided by subacute rehabilitation facilities.…”

“…Patients are discharged to home or a subacute setting, such as a skilled nursing facility (SNF) or acute rehabilitation after surgery. Discharge to SNF may have unintended consequences such as increased cost and increased risk of infection 4–7 . The inpatient physical therapy evaluation (PTE) is critical for discharge planning, but the role of this assessment in discharge planning has not been fully elucidated after cervical spine surgery for DCM 8 …”