School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, Bathurst, NSW, 2795, Australia.
BMC Health Serv Res. 2023 Oct 19;23(1):1126. doi: 10.1186/s12913-023-10119-0.
Diabetic foot infection (DFI), including diabetic foot ulcer, is a serious complication of diabetes, particularly in the South Western Sydney (SWS) region where it is a leading cause of diabetes-related hospitalisations. Multidisciplinary team (MDT) involvement is effective at improving the health outcomes of DFI patients. This study investigated the impact of MDT (High Risk Foot Service, HRFS) on the length of stay and surgical outcomes of inpatients with DFI in a Sydney tertiary hospital.
A retrospective audit of electronic medical records of inpatient admissions for DFI at Campbelltown Hospital between January 2019 - December 2021, was performed. The main outcome of the study was MDT involvement, defined as having two or more specialities involved in the patient's treatment. The other measured variables included length of stay (defined as the total duration from admission to discharge), and surgical outcomes including debridement, minor amputation, and major amputation.
Over the three years, 78 participants presented to the hospital for 89 unique DFI admissions. There were 24 admissions in 2019, 28 admissions in 2020, and 37 admissions in 2021, with MDT attendance showing a steady increase at 62.5%, 75.0% and 83.8% respectively. Patients with serious comorbidities such as chronic kidney disease were more likely to have MDT involvement (84.8% vs. 15.2%, P = 0.048). Imaging was more likely to be performed with MDT involvement (78.8% vs. 21.3%, p < 0.05). Comparing patients who received and did not receive MDT care, the mean HbA1c (%) (8.4 ± 2.0 vs. 8.2 ± 2.7, P = 0.701), median length of stay (LOS: 7.8, IQR 15.0 days vs. 4.8 IQR 7.9 days, P = 0.243) and rate of surgical outcomes (74.6% vs. 72.7%, P = 0.262) were similar. Patients who required major amputation had significantly longer LOS (24 days, IQR 21.5 vs. 5.2 days, IQR 13.0, P = 0.004) but similar HbA1c (P = 0.552) compared to those who had conservative intervention.
Adopting an MDT approach was associated with more thorough investigation of DFI, with similar rates of surgical outcomes. Further research on the impacts of MDT on length of stay and surgical outcomes of DFI patients in other SWS hospitals is needed.
糖尿病足感染（DFI），包括糖尿病足溃疡，是糖尿病的一种严重并发症，特别是在西南悉尼（SWS）地区，它是导致糖尿病相关住院的主要原因。多学科团队（MDT）的参与可有效改善 DFI 患者的健康结局。本研究调查了 MDT（高危足部服务，HRFS）对悉尼一家三级医院 DFI 住院患者住院时间和手术结果的影响。
对 2019 年 1 月至 2021 年 12 月坎贝尔敦医院 DFI 住院患者的电子病历进行回顾性审核。本研究的主要结果是 MDT 参与，定义为两名或两名以上专科医生参与患者的治疗。其他测量变量包括住院时间（定义为入院至出院的总持续时间）和手术结果，包括清创、小截肢和大截肢。
在三年期间，78 名患者因 89 例不同的 DFI 入院。2019 年有 24 例入院，2020 年有 28 例入院，2021 年有 37 例入院，MDT 参与率分别为 62.5%、75.0%和 83.8%，呈稳步上升趋势。患有慢性肾病等严重合并症的患者更有可能接受 MDT 治疗（84.8%对 15.2%，P=0.048）。MDT 参与时更有可能进行影像学检查（78.8%对 21.3%，p<0.05）。与接受和未接受 MDT 护理的患者相比，平均糖化血红蛋白（%）（8.4±2.0 对 8.2±2.7，P=0.701）、中位住院时间（LOS：7.8，IQR 15.0 天对 4.8 IQR 7.9 天，P=0.243）和手术结果率（74.6%对 72.7%，P=0.262）相似。需要大截肢的患者 LOS 明显更长（24 天，IQR 21.5 对 5.2 天，IQR 13.0，P=0.004），但糖化血红蛋白相似（P=0.552），与接受保守治疗的患者相比。
采用 MDT 方法与 DFI 的更彻底调查相关，手术结果率相似。需要对 SWS 地区其他医院 DFI 患者的 MDT 对住院时间和手术结果的影响进行进一步研究。
