Surgical diabetic foot debridement: improving training and practice utilizing the traffic light principle
Author(s)
Type
Journal Article
Abstract
Comprehensive management of a severe diabetic foot infection focus on clear treatment pathways. Including rapid, radical debridement of all infection in addition to intravenous antibiotics and supportive measures. However, inexperienced surgeons can often underestimate the extent of infection, risking inadequate debridement, repeated theatre episodes, higher hospital morbidity, and hospital length of stay (LOS). This study aims to assess protocolized diabetic-foot-debridement: Red-Amber-Green (RAG) model as part of a value-based driven intervention. The model highlights necrotic/infected tissue (red-zone, nonviable), followed by areas of moderate damage (amber-zone), healthy tissue (green-zone, viable). Sequential training of orthopedic surgeons supporting our emergency service was undertaken prior to introduction. We compared outcomes before/after RAG introduction (pre-RAG, n = 48; post- RAG, n = 35). Outcomes measured included: impact on number of debridement/individual admission, percentage of individuals requiring multiple debridement, and length-of-hospital-stay as a function-of-cost. All-patients fulfilled grade 2/3, stage-B, of the Texas-Wound-Classification. Those with evidence of ischemia were excluded. The pre-RAG-group were younger (53.8 ± 11.0 years vs 60.3 ± 9.2 years, P = .01); otherwise the 2-groups were matched: HbA1c, white blood cell count, and C-reactive protein. The post-RAG-group underwent significantly lower numbers of debridement's (1.1 ± 0.3 vs 1.5 ± 0.6/individual admission, P = .003); equired fewer visits to theatre (8.6% vs 38%, P = .003), their LOS was reduced (median LOS pre-RAG 36.0 vs post-RAG 21.5 days, P = .02). RAG facilitates infection clearance, fewer theatre-episodes, and shorter LOS. This protocolized-management-tools in acute severely infected diabetic foot infection offers benefits to patients and health-care-gain.
Date Issued
2019-09-01
Date Acceptance
2019-06-01
Citation
International Journal of Lower Extremity Wounds, 2019, 18 (3), pp.279-286
ISSN
1534-7346
Publisher
SAGE Publications
Start Page
279
End Page
286
Journal / Book Title
International Journal of Lower Extremity Wounds
Volume
18
Issue
3
Copyright Statement
© The Author(s) 2019. The final, definitive version of this paper has been published in International Journal of Lower Extremity Wounds by Sage Publications Ltd. All rights reserved. It is available at: https://journals.sagepub.com/doi/10.1177/1534734619853657
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31237147
Subjects
diabetic foot
foot attack
surgical debridement
training
value-based health care
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-06-25