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Effectiveness of fast-track pathway for diabetic foot ulcerations
AIM: To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS: The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referr...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Milan
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413149/ https://www.ncbi.nlm.nih.gov/pubmed/33942178 http://dx.doi.org/10.1007/s00592-021-01721-x |
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author | Meloni, Marco Lazaro-Martínez, Jose Luis Ahluwalia, Raju Bouillet, Benjamin Izzo, Valentina Di Venanzio, Michela Iacopi, Elisabetta Manu, Chris Garcia-Klepzig, José Luis Sánchez-Ríos, Juan Pedro Lüedemann, Claas De Buruaga, Víctor Rodriguez-Saenz Vouillarmet, Julien Guillaumat, Jérôme Aleandri, Anna Rita Giurato, Laura Edmonds, Micheal Piaggesi, Alberto Van Acker, Kristien Uccioli, Luigi |
author_facet | Meloni, Marco Lazaro-Martínez, Jose Luis Ahluwalia, Raju Bouillet, Benjamin Izzo, Valentina Di Venanzio, Michela Iacopi, Elisabetta Manu, Chris Garcia-Klepzig, José Luis Sánchez-Ríos, Juan Pedro Lüedemann, Claas De Buruaga, Víctor Rodriguez-Saenz Vouillarmet, Julien Guillaumat, Jérôme Aleandri, Anna Rita Giurato, Laura Edmonds, Micheal Piaggesi, Alberto Van Acker, Kristien Uccioli, Luigi |
author_sort | Meloni, Marco |
collection | PubMed |
description | AIM: To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS: The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS: Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION: After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival. |
format | Online Article Text |
id | pubmed-8413149 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Milan |
record_format | MEDLINE/PubMed |
spelling | pubmed-84131492021-09-22 Effectiveness of fast-track pathway for diabetic foot ulcerations Meloni, Marco Lazaro-Martínez, Jose Luis Ahluwalia, Raju Bouillet, Benjamin Izzo, Valentina Di Venanzio, Michela Iacopi, Elisabetta Manu, Chris Garcia-Klepzig, José Luis Sánchez-Ríos, Juan Pedro Lüedemann, Claas De Buruaga, Víctor Rodriguez-Saenz Vouillarmet, Julien Guillaumat, Jérôme Aleandri, Anna Rita Giurato, Laura Edmonds, Micheal Piaggesi, Alberto Van Acker, Kristien Uccioli, Luigi Acta Diabetol Original Article AIM: To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS: The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS: Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION: After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival. Springer Milan 2021-05-03 2021 /pmc/articles/PMC8413149/ /pubmed/33942178 http://dx.doi.org/10.1007/s00592-021-01721-x Text en © The Author(s) 2021, corrected publication 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Meloni, Marco Lazaro-Martínez, Jose Luis Ahluwalia, Raju Bouillet, Benjamin Izzo, Valentina Di Venanzio, Michela Iacopi, Elisabetta Manu, Chris Garcia-Klepzig, José Luis Sánchez-Ríos, Juan Pedro Lüedemann, Claas De Buruaga, Víctor Rodriguez-Saenz Vouillarmet, Julien Guillaumat, Jérôme Aleandri, Anna Rita Giurato, Laura Edmonds, Micheal Piaggesi, Alberto Van Acker, Kristien Uccioli, Luigi Effectiveness of fast-track pathway for diabetic foot ulcerations |
title | Effectiveness of fast-track pathway for diabetic foot ulcerations |
title_full | Effectiveness of fast-track pathway for diabetic foot ulcerations |
title_fullStr | Effectiveness of fast-track pathway for diabetic foot ulcerations |
title_full_unstemmed | Effectiveness of fast-track pathway for diabetic foot ulcerations |
title_short | Effectiveness of fast-track pathway for diabetic foot ulcerations |
title_sort | effectiveness of fast-track pathway for diabetic foot ulcerations |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413149/ https://www.ncbi.nlm.nih.gov/pubmed/33942178 http://dx.doi.org/10.1007/s00592-021-01721-x |
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