Department of Surgery, University of North Carolina School of Medicine, Chapel Hill.
North Carolina Jaycee Burn Center, Chapel Hill.
J Burn Care Res. 2020 Sep 23;41(5):981-985. doi: 10.1093/jbcr/iraa106.
In patients with diabetes mellitus (DM), amputation rates exceed 30% when lower extremity osteomyelitis is present. We sought to determine the rate of osteomyelitis and any subsequent amputation in our patients with DM and lower extremity burns. We performed a single-site, retrospective review at our burn center using the institutional burn center registry, linked to clinical and administrative data. Adults (≥18 years old) with DM admitted from January 1, 2014 to December 31, 2018 for isolated lower extremity burns were eligible for inclusion. We evaluated demographics, burn characteristics, comorbidities, presence of radiologically confirmed osteomyelitis, length of stay (LOS), inpatient hospitalization costs, and amputation rate at 3 months and 12 months after injury. We identified 103 patients with DM and isolated lower extremity burns. Of these, 88 patients did not have osteomyelitis, while 15 patients had radiologically confirmed osteomyelitis within 3 months of the burn injury. Compared to patients without osteomyelitis, patients with osteomyelitis had significantly increased LOS (average LOS 22.7 days vs 12.1 days, P = .0042), inpatient hospitalization costs (average $135,345 vs $62,237, P = .0008), amputation rate within 3 months (66.7% vs 5.70%, P < .00001), and amputation rate within 12 months (66.7% vs 9.1%, P < .0001). The two groups were otherwise similar in demographics, burn injury characteristics, access to healthcare, and preexisting comorbidities. Patients with DM and lower extremity burns incurred increased LOS, higher inpatient hospitalization costs, and increased amputation rates if radiologically confirmed osteomyelitis was present within 3 months of the burn injury.
在患有糖尿病（DM）的患者中，当下肢骨髓炎存在时，截肢率超过 30%。我们旨在确定患有 DM 和下肢烧伤的患者中骨髓炎的发生率以及随后的任何截肢。我们在烧伤中心进行了一项单站点回顾性研究，使用机构烧伤中心登记处，并与临床和行政数据相关联。 2014 年 1 月 1 日至 2018 年 12 月 31 日，年龄在 18 岁以上（≥18 岁），因孤立性下肢烧伤而住院的 DM 患者符合纳入标准。我们评估了人口统计学，烧伤特征，合并症，放射学确诊骨髓炎的存在，住院时间（LOS），住院费用以及受伤后 3 个月和 12 个月的截肢率。我们确定了 103 例患有 DM 和孤立性下肢烧伤的患者。其中，88 例患者无骨髓炎，而 15 例患者在烧伤后 3 个月内放射学确诊骨髓炎。与无骨髓炎的患者相比，患有骨髓炎的患者 LOS 明显延长（平均 LOS 为 22.7 天 vs 12.1 天，P =.0042），住院费用（平均为 135345 美元 vs 62237 美元，P =.0008），3 个月内截肢率（66.7% vs 5.70%，P <.00001）和 12 个月内截肢率（66.7% vs 9.1%，P <.0001）。在人口统计学，烧伤损伤特征，获得医疗保健和并存疾病方面，两组患者均相似。如果在烧伤后 3 个月内放射学确认骨髓炎，则患有 DM 和下肢烧伤的患者会增加 LOS，更高的住院费用和更高的截肢率。
