Definitive single-stage surgery for treating diabetic foot osteomyelitis: a protocolized pathway including antibiotic bone graft substitute use
Publication Details
Chow, J.,
Imani, S.,
Kavisinghe, I.,
Mittal, R.,
&
Martin, B.
(2024).
Definitive single-stage surgery for treating diabetic foot osteomyelitis: a protocolized pathway including antibiotic bone graft substitute use.
ANZ Journal of Surgery,.
Abstract
Background: Diabetic foot ulcers (DFUs) are a challenging complication of diabetes mellitus, often leading to poor clinical outcomes and significant socioeconomic burdens. We evaluated the effectiveness of a definitive single-stage protocolized surgical management pathway, including the use of local antibiotic bone graft substitute, for the treatment of infected DFUs with associated osteomyelitis.
Methods: A retrospective cohort study was conducted. Medical records were extracted(from January 2017 to December 2020) to establish a database consisting of patients who underwent surgical intervention for the treatment of an infected DFU with osteomyelitis .Patients were divided into conventional (control) and protocolized (intervention) surgical groups depending on the treatment received. Clinical outcomes were assessed over a12-month follow-up period.
Results: A total of 136 consecutive patients were included (conventional = 33,protocolized = 103). The protocolized group demonstrated a statistically significant reduc-tion in the mean number of operations performed per patient (1.2 vs. 3.5) (P < 0.001) and ashorter accumulative hospital length of stay (12.6 vs. 25.1 days) (P < 0.001) compared tothe conventional group. Major amputation rates were significantly lower in the protocolizedgroup (2% vs. 18%) (P < 0.001). Within 12 months of surgical intervention, the protocolized group exhibited an ulcer healing rate of 89%, with a low rate of recurrence (3%).
Conclusion: The protocolized surgical pathway, including local antibiotic bone graft substitute use, demonstrated superior outcomes compared to conventional management for the treatment of infected DFUs with osteomyelitis. Further research is needed to evaluate the cost-effectiveness and generalizability of this approach.
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