Association of Preulcerative Foot Care and Outcomes of Diabetic Foot Ulceration.

IF 0.5 4区 医学 Q4 ORTHOPEDICS Journal of the American Podiatric Medical Association Pub Date : 2024-03-01 DOI:10.7547/22-071
Tze-Woei Tan, Jeffrey P Tolson, Juan C Arias Aristizabal, Diego J Urbina, Sarah A Fermawi, Craig Weinkauf, David G Marrero, David G Armstrong
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Abstract

Background: The purpose of this study was to determine the association of preulcerative foot care and outcomes of diabetic foot ulcerations (DFUs).

Methods: This retrospective cohort study using the Mariner all-payers claims data set included participants with a new DFU from 2010 to 2019. Patients were stratified into two cohorts (foot care and control) based on whether they had received any outpatient foot care within 12 months before DFU. Adjusted comparison was performed by propensity matching for age, sex, and the Charlson Comorbidity Index (1:2 ratio). Kaplan-Meier estimates and logistic regression examined the association between foot care and outcomes of DFUs.

Results: Of the 307,131 patients in the study cohort, 4.7% (n = 14,477) received outpatient preulcerative foot care within the 12-month period before DFU. The rate of major amputation was 1.8% (foot care, 1.2%), and 9.0% of patients had hospitalizations for foot infection within 12 months after DFU (foot care, 7.8%). In the study cohort, patients who received pre-DFU foot care had greater major amputation-free survival (P < .001) on Kaplan-Meier estimate. In both the study and matched cohorts, multivariable analysis demonstrated that foot care was associated with lower odds of major amputation for both study (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.48-0.66) and matched (OR, 0.61; 95% CI, 0.51-0.72) cohorts, and lower odds of hospitalizations for a foot infection in both study (OR, 0.91; 95% CI, 0.86-0.96) and matched (OR, 0.88, 95% CI, 0.82-0.94) cohorts.

Conclusions: Among patients with a new DFU, those who received outpatient preulcerative foot care within 12 months of diagnosis had lower risks of major amputation and hospitalizations for foot infection.

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溃疡前足部护理与糖尿病足溃疡预后的关系
背景:本研究旨在确定溃疡前足部护理与糖尿病足溃疡(DFUs)预后的关系:本研究旨在确定溃疡前足部护理与糖尿病足溃疡(DFU)预后之间的关系:这项回顾性队列研究使用了 Mariner 所有支付者的索赔数据集,包括 2010 年至 2019 年期间新发 DFU 的参与者。根据患者在DFU发生前12个月内是否接受过任何足部门诊护理,将患者分为两个队列(足部护理队列和对照队列)。根据年龄、性别和夏尔森综合症指数(1:2 比例)进行倾向匹配,进行调整比较。卡普兰-梅耶估计值和逻辑回归检验了足部护理与 DFUs 结果之间的关联:在研究队列的 307,131 名患者中,4.7%(n = 14,477)的患者在 DFU 发生前的 12 个月内接受了溃疡前足部门诊治疗。重大截肢率为 1.8%(足部护理,1.2%),9.0% 的患者在 DFU 后 12 个月内因足部感染住院(足部护理,7.8%)。在研究队列中,根据 Kaplan-Meier 估计,接受 DFU 前足部护理的患者无重大截肢的存活率更高(P < .001)。在研究队列和匹配队列中,多变量分析表明,足部护理与较低的大截肢几率相关,无论是研究队列(几率比 [OR],0.56;95% 置信区间 [CI],0.48-0.66)还是匹配队列(OR,0.56;95% 置信区间 [CI],0.48-0.66)。在研究队列(OR,0.91;95% CI,0.86-0.96)和匹配队列(OR,0.88,95% CI,0.82-0.94)中,足部护理与较低的大截肢几率相关,与较低的足部感染住院几率相关:结论:在新发 DFU 患者中,确诊后 12 个月内接受足部溃疡前门诊治疗的患者截肢和因足部感染住院的风险较低。
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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
128
审稿时长
6-12 weeks
期刊介绍: The Journal of the American Podiatric Medical Association, the official journal of the Association, is the oldest and most frequently cited peer-reviewed journal in the profession of foot and ankle medicine. Founded in 1907 and appearing 6 times per year, it publishes research studies, case reports, literature reviews, special communications, clinical correspondence, letters to the editor, book reviews, and various other types of submissions. The Journal is included in major indexing and abstracting services for biomedical literature.
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