Analysis of specialized care for patients with diabetic foot syndrome in St. Petersburg for 2010–2021

Abstract

BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus.AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021.MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices «Diabetic foot» (DFO) from 2010 to 2021 were analyzed.RESULTS: The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers — 8,9%, with Charcot’s arthropathy — less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality — from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021.CONCLUSION: An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality.