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Beitragstitel The influence of the timing and sequence of revascularization (before or after amputation) on the outcomes of diabetic foot infections - a single-centre, retrospective pilot evaluation
Beitragscode P53
Autoren
  1. Felix Waibel Universitätsklinik Balgrist
  2. Vinoth Yogarasa Balgrist University Hospital
  3. Madlaina Schöni Universitätsklinik Balgrist
  4. Martin Berli Balgrist University Hospital
  5. Ilker Uçkay Universitätsklinik Balgrist Vortragender
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 2 | Infekte
Abstract Introduction:
The management of diabetic foot infections (DFI) is multidisciplinary. Conceptually, the revascularization (if possible) occurs before surgery, but sometimes not. We assess the sequence of both interventions regarding clinical failures of DFI therapy.

Methods:
Case-control cohort study with primary outcome "clinical failure" (surgical revision for infection, relapse of infection, ischemia, or wound failures). We target the perioperative time period two weeks before and two weeks after the surgery/amputation.

Results:
Among 1,013 DFI episodes in 586 patients (219 females, median age 67 years; 607 smokers with a median of 10 pack-years; 882 cases with osteomyelitis; 85 with renal dialysis; 277 with peripheral arterial disease grade >= 3), 572 DFI episodes (56%) were revascularized (562 angioplasties, 62 vascular surgeries) with a median delay of 7 days prior to surgery. All DFI episodes were debrided or (partially) amputated (median 1 surgical intervention), of which 106 major amputations. The median length of antibiotic therapy was 20 days (initially 5 days parenterally) and the median clinical follow-up 5.5 years.

We revised 245 DFI episodes surgically (245/1,013; 25%). In crude group comparisons, DFIs with the need for revascularization ultimately failed more often that those without (164 failures/572 vascularization (29%) versus 91 failures/441 non-vascularization (21%); p < 0 .01), whereas major amputations or a vascularization before surgery (51/169 vs. 8/25; p=0.30) were indifferent. In the multivariate Cox regression analysis with the outcome "clinical failure", the time delay between surgery and vascularization (HR 1.0, 95%CI 1.0-1.0), or revascularization performed before the surgery (HR 1.0, 95%CI 1.9-0.5-7.7) were not protective of failures. In contrast, a persisting nicotin abuse was clearly associated with failures (HR 2.6, 95% 1.1-6.2). The age, antibiotic therapy, anticoagulation, and past revascularizations were all indifferent.

Conclusions:
Retrospectively and within two weeks perioperatively, the exact timing or the sequence, of revascularization, had no influence on failures of DFI treatment. As in many fields of surgery in ischemic areas, surgeons should encourage the patient to stop smoking.