Open AccessPostoperative healing in the diabetic foot is impacted by discharge destination
Author(s) -
Burmeister Rebecca A.,
Jarocki Christine,
Holmes Crystal M.,
Rothenberg Gary M.,
Munson Michael E.,
Schmidt Brian M.
Publication year - 2021
Publication title -
international wound journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.867
H-Index - 63
eISSN - 1742-481X
pISSN - 1742-4801
DOI - 10.1111/iwj.13567
Subject(s) - medicine , amputation , diabetes mellitus , comorbidity , diabetic foot , foot (prosody) , surgery , podiatry , univariate analysis , diabetic foot ulcer , multivariate analysis , observational study , clearance , osteomyelitis , linguistics , philosophy , alternative medicine , pathology , urology , endocrinology
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 x ¯ =5.33 ± 2.84 vs SNF x ¯ =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.