Biochemical and patient factors as predictors for multiple surgeries in diabetic foot disease

Abstract

Diabetic foot disease (DFD) bestows a huge surgical burden on patients and health care systems worldwide. Medical and surgical management centres around limb preservation and maintaining patient mobility. Despite vast experience in managing DFD, little is understood about the surgical prognosis of a patient presenting for their first DFD procedure.We evaluated for predictive factors, observable at a patient's first presentation for a surgical procedure on their diabetic foot, which may indicate an increased likelihood of requiring similar procedures in the future.Method: Our study included 70 patients with diabetes mellitus who underwent surgery on their diabetic foot. These patients were split into cohorts. Cohort 1 received only one surgery on their diabetic foot; Cohort 2 received multiple surgeries on their diabetic foot. Statistical analysis was conducted looking at various parameters between the cohorts to assess for any significant differences at the time of first surgery.Results: On Mann‐Whitney U test, there was a significant difference in C‐reactive protein (CRP) between patients who had a single surgery and those receiving multiple surgeries (p=0.009). A binomial logistic regression model found CRP to be a significant predictor of whether a patient will undergo one surgery or multiple surgeries (Exp[B] 0.988, 95% CI 0.978–0.998). On analysis of the ROC curve, 84mg/L was the best cut‐off for CRP in predicting number of surgeries.Clinical relevance: These predictive factors could highlight patients who are ‘at risk’ for needing further procedures, so they can be managed with more intense surveillance and follow‐up. Copyright © 2024 John Wiley & Sons.