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Outpatient Foot-Sparing Surgery Is Safe in Selected Patients with Diabetic Foot Infections
Javier Aragón-Sánchez1, Gerardo Víquez-Molina, María Eugenia López-Valverde
1Javier Aragón-Sánchez, MD, PhD, is Chief, Department of Surgery and Diabetic Foot Unit and Medical Director, La Paloma Hospital, Las Palmas de Gran Canaria, Spain. Gerardo Víquez-Molina, MD, is Head, Diabetic Foot Unit, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José de Costa Rica, Costa Rica. María Eugenia López-Valverde, MD, is Specialist in Endocrinology and Nutrition, Hospital Juan Ramón Jiménez, Huelva, Spain Cristina Aragón-Hernández, MD, is Resident, Geriatrics Service, University Getafe Hospital, Madrid, Spain. Also at La Paloma Hospital, Javier Aragón-Hernández, MD, is Research Fellow, Surgery and Diabetic Foot Unit. José María Rojas-Bonilla, MD, is Physician, Diabetic Foot Unit, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José de Costa Rica, Costa Rica.
Objective:
To determine if outpatient foot-sparing surgery for patients with diabetic foot infections (DFIs) is associated with a higher rate of treatment failure or longer healing time.
Methods:
In this prospective observational study, the authors consecutively recruited a cohort of 200 patients with moderate and severe DFIs from the Diabetic Foot Unit of Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José de Costa Rica, Costa Rica from October 15, 2020 to December 15, 2021. They compared outpatients with those admitted. Cox univariate analysis was performed, with time to treatment failure and time to healing as dependent variables and outpatient management as the independent variable.
Results:
Seventy-one patients underwent surgery on an outpatient basis (35.5%), and 129 (64.5%) were admitted. Sixty of 111 patients (54.1%) with moderate infections were treated as outpatients versus 11 of 89 (12.4%) of those with severe infections. Twelve (16.9%) of the outpatients and 26 (20.2%) of those admitted presented failure (P = .57). The Cox univariate analysis with time to failure of treatment associated with outpatient management reported a hazard ratio of 1.26 (95% CI, 0.64-2.50; P = .50), and the analysis regarding healing time reported a hazard ratio of 0.91 (95% CI, 0.66-1.25; P = .56).
Conclusions:
Foot-sparing surgery on an outpatient basis was safe in more than half the cases of moderate DFIs, especially in patients with osteomyelitis. This approach is not associated with treatment failure or a longer healing time. Patients with severe infections, penetrating injuries, necrosis, or high inflammatory response and those with peripheral arterial disease who require revascularizations should be admitted to the hospital.
