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Analyzing Treatment Aggressiveness and Identifying High-Risk Patients in Diabetic Foot Ulcer Return to Care
Austin C. Remington, B.A., Tina Hernandez-Boussard, Ph.D., James Chang, M.D., Catherine Curtin, M.D..
Stanford University School of Medicine, Stanford, CA, USA.

PURPOSE: Plastic and reconstructive surgery techniques are often required in managing the complex wounds that result from diabetic foot ulcers. This retrospective study analyzed subjects with diabetes mellitus and distal foot ulcers to determine the factors that predict hospital readmission.
METHODS: The cohort was constructed from patient discharges containing diagnosis codes for both diabetes mellitus and distal foot ulcer. Data were collected from the State Inpatient Database and State Emergency Department Database from the Agency for Healthcare Research and Quality in Florida and New York, 2011-2012. All-cause 30-day return to care admissions (emergency room or inpatient admission) were identified.
RESULTS: Our cohort included 25,911 patients, of which 21% underwent a toe or midfoot amputation during their index stay. The whole cohort rate of return to care within 30 days was 30%, whereas the toe or midfoot amputation group had a significantly lower readmission rate of 25% (p<0.05). The most common diagnosis codes upon readmission were diabetes mellitus (19%) and infection (13%). In a multiple regression model, patients with a toe or midfoot amputation procedure had 22% lower odds of readmission (p<0.05). Other demographic factors such as comorbidities, Black and Hispanic ethnicities, and Medicare and Medicaid payers were associated with higher odds of readmission following initial hospitalization (p<0.05).
CONCLUSION: The results of this study suggest that aggressive management of diabetic foot ulcer patients may decrease odds of return to inpatient or emergency department care. Understanding patients at high-risk for readmission can improve counseling and treatment strategies for this fragile patient population.


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