Surgical Diabetic Foot Debridement: Improving Training and Practice Utilizing the Traffic Light Principle
| Autor: | Ines L.H. Reichert, Aaditya Sinha, Venu Kavarthapu, Prashant R J Vas, Michael Edmonds, Raju Ahluwalia, Saif Sait, Joseph Tam, Chris Manu, Erika Vainieri |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Inservice Training medicine.medical_treatment Severity of Illness Index CULTURE 0302 clinical medicine Clinical Protocols Outcome Assessment Health Care Orthopedic Procedures 030212 general & internal medicine training COST General Medicine Middle Aged Anti-Bacterial Agents ULCERS medicine.anatomical_structure value-based health care Administration Intravenous Female Life Sciences & Biomedicine diabetic foot Adult Models Educational medicine.medical_specialty Ischemia Length of hospitalization 030209 endocrinology & metabolism Healthy tissue Dermatology PATIENT surgical debridement 03 medical and health sciences Traffic signal White blood cell MANAGEMENT medicine Humans foot attack Aged Wound Healing Science & Technology Debridement business.industry Dermatology & Venereal Diseases 1103 Clinical Sciences Length of Stay CARE medicine.disease Diabetic foot United Kingdom Surgery Orthopedic surgery Wound Infection business |
| Zdroj: | The International Journal of Lower Extremity Wounds. 18:279-286 |
| ISSN: | 1552-6941 1534-7346 |
| DOI: | 10.1177/1534734619853657 |
| Popis: | Comprehensive management of a severe diabetic foot infection focus on clear treatment pathways. Including rapid, radical debridement of all infection in addition to intravenous antibiotics and supportive measures. However, inexperienced surgeons can often underestimate the extent of infection, risking inadequate debridement, repeated theatre episodes, higher hospital morbidity, and hospital length of stay (LOS). This study aims to assess protocolized diabetic-foot-debridement: Red-Amber-Green (RAG) model as part of a value-based driven intervention. The model highlights necrotic/infected tissue (red-zone, nonviable), followed by areas of moderate damage (amber-zone), healthy tissue (green-zone, viable). Sequential training of orthopedic surgeons supporting our emergency service was undertaken prior to introduction. We compared outcomes before/after RAG introduction (pre-RAG, n = 48; post- RAG, n = 35). Outcomes measured included: impact on number of debridement/individual admission, percentage of individuals requiring multiple debridement, and length-of-hospital-stay as a function-of-cost. All-patients fulfilled grade 2/3, stage-B, of the Texas-Wound-Classification. Those with evidence of ischemia were excluded. The pre-RAG-group were younger (53.8 ± 11.0 years vs 60.3 ± 9.2 years, P = .01); otherwise the 2-groups were matched: HbA1c, white blood cell count, and C-reactive protein. The post-RAG-group underwent significantly lower numbers of debridement’s (1.1 ± 0.3 vs 1.5 ± 0.6/individual admission, P = .003); equired fewer visits to theatre (8.6% vs 38%, P = .003), their LOS was reduced (median LOS pre-RAG 36.0 vs post-RAG 21.5 days, P = .02). RAG facilitates infection clearance, fewer theatre-episodes, and shorter LOS. This protocolized-management-tools in acute severely infected diabetic foot infection offers benefits to patients and health-care-gain. |
| Databáze: | OpenAIRE |
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