Getting a Foothold on Diabetic Foot Disease—Outcomes of a Multidisciplinary Clinical Pathway for Inpatient Diabetic Foot Care: A 17-Year Institutional Review

Abstract

Introduction Diabetes foot disease (DFD) contributes to poor quality of life, clinical and economic burden. Multidisciplinary diabetes foot teams provide prompt access to specialist teams thereby improving limb salvage. We present a 17-year review of an inpatient multidisciplinary clinical care path (MCCP) for DFD in Singapore. Methods This was a retrospective cohort study of patients admitted for DFD and enrolled in our MCCP to a 1700-bed university hospital from 2005 to 2021. Results There were 9279 patients admitted with DFD with a mean of 545 (±119) admissions per year. The mean age was 64 (±13.3) years, 61% were Chinese, 18% Malay and 17% Indian. There was a higher proportion of Malay (18%) and Indian (17%) patients compared to the country's ethnic composition. A third of the patients had end stage renal disease and prior contralateral minor amputation. There was a reduction in inpatient major lower extremity amputation (LEA) from 18.2% in 2005 to 5.4% in 2021 (odds ratio 0.26, 95% confidence interval 0.16-0.40, P < .001) which was the lowest since pathway inception. Mean time from admission to first surgical intervention was 2.8 days and mean time from decision for revascularization to procedure was 4.8 days. The major-to-minor amputation rate reduced from 1.09 in 2005 to 0.18 in 2021, reflecting diabetic limb salvage efforts. Mean and median length of stay (LOS) for patients in the pathway was 8.2 (±14.9) and 5 (IQR = 3) days, respectively. There was a gradual trend of increase in the mean LOS from 2005 to 2021. Inpatient mortality and readmission rate was stable at 1% and 11%. Conclusion Since the institution of a MCCP, there was a significant improvement in major LEA rate. An inpatient multidisciplinary diabetic foot care path helped to improve care for patients with DFD.

Bibliometric analysis of systematic review and meta-analysis on diabetic foot ulcer

“…Debridement drastically reduces the risk of infection and amputation [ 35 , 36 ], dressings ensure that the wound is moist and exudation well controlled [ 37 , 38 ], platelet-derived products facilitate wound healing [ 39 , 40 ], glycaemic control delays microangiopathy [ 14 , 41 ], and telemedicine provides continuous, expert management guidance [ 10 , 42 ]. This study further emphasizes the significance of multidisciplinary care [ 43 , 44 ].…”

Multi‐disciplinary diabetic limb salvage programme in octogenarians with diabetic foot ulcers is not futile: An observational study with historical controls

“…While there was no significant difference in number of inpatient admissions between the age groups, patients aged ≥80 years exhibited a shorter LOS, potentially indicative of the DLS programme's success in averting DFU complications and improving patients' overall health. This shorter LOS may be partially attributed to the inclusion of a specialised geriatric surgical service 27,28 within the inpatient diabetic foot pathway. These findings resonate with a previous study demonstrating improved limb salvage outcomes through revascularisation in patients over 80 years old with critical limb ischemia 25 .…”