López Capdevilla Laia, Santamaría Fumas Alejandro, Sales Pérez José Miguel, Domínguez Sevilla Alejandro, Del Corral Cuervo Julio, Varela-Quintana Carlos, Rabanal Rubio María, Roza Miguel Pablo
Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, Barcelona 08025, Spain.
Consorci Sanitari Integral, Barcelona, Spain.
Ther Adv Endocrinol Metab. 2024 Oct 7;15:20420188241271795. doi: 10.1177/20420188241271795. eCollection 2024.
Charcot foot is a severe complication of diabetes mellitus. Amputation is associated with 5-year mortality rates as high as 70%, and the overall treatment cost for diabetic foot surpasses that of conditions such as cancer or depression.
To compare clinical, quality-of-life, and cost outcomes related to Charcot foot management through two distinct treatments: amputation and resection with stabilization using circular external fixation (CEF).
This retrospective study included all adult patients treated at our unit between 2008 and 2022 for acute diabetic foot with infected ulcers. The allocation to treatment groups was based on the timing of patient enrollment. We gathered anthropometric, diagnostic, and surgical data, documenting individualized costs for preoperative, postoperative, and rehabilitation phases. Health status was assessed using the EQ-5D-3L questionnaire, and recorded data included mortality.
A total of 31 patients (18 amputations; 13 CEF) were included. Amputees exhibited significantly higher mortality compared to those with a CEF (44.8% vs 7.7%, = 0.045). The estimated 3-year survival was 60.8% for amputees and 90% for the CEF group (log-rank test, = 0.096). In terms of quality of life (EQ-5D-3L), amputees reported a reduction of 14.67 points while CEF patients reported an increase of 40.39 points ( < 0.001). The EQ-5D-3L index improved by 1.8 points for amputees, as compared with 62.3 points in the CEF group ( < 0.001). The total mean cost of managing an amputated patient was €222,864, practically identical to the €224,438 incurred in the CEF group ( = 0.767). No statistically significant differences were found in the time distribution of costs. However, some specific expense items demonstrated statistical significance.
In treating infected diabetic foot ulcers, external fixation leads to a better quality of life compared to amputation. There's also a trend suggesting higher survival rates with external fixation, and both approaches have similar costs.
夏科氏足是糖尿病的一种严重并发症。截肢与高达70%的5年死亡率相关，糖尿病足的总体治疗成本超过癌症或抑郁症等疾病。
通过两种不同的治疗方法比较与夏科氏足治疗相关的临床、生活质量和成本结果：截肢以及使用环形外固定（CEF）进行切除并稳定化处理。
这项回顾性研究纳入了2008年至2022年间在本单位接受治疗的所有成年急性糖尿病足伴感染性溃疡患者。治疗组的分配基于患者入组时间。我们收集了人体测量、诊断和手术数据，记录术前、术后和康复阶段的个体化成本。使用EQ-5D-3L问卷评估健康状况，记录的数据包括死亡率。
共纳入31例患者（18例行截肢术；13例行CEF）。与接受CEF治疗的患者相比，截肢患者的死亡率显著更高（44.8%对7.7%，P = 0.045）。截肢患者的估计3年生存率为60.8%，CEF组为90%（对数秩检验，P = 0.096）。在生活质量（EQ-5D-3L）方面，截肢患者报告降低了[14.67分]，而CEF患者报告提高了40.39分（P < 0.001）。截肢患者的EQ-5D-3L指数提高了1.8分，而CEF组提高了62.3分（P < 0.001）。管理一名截肢患者的总平均成本为222,864欧元，与CEF组产生的224,438欧元几乎相同（P = 0.767）。在成本的时间分布上未发现统计学显著差异。然而，一些特定费用项目显示出统计学显著性。
在治疗感染性糖尿病足溃疡方面，与截肢相比，外固定可带来更好的生活质量。也有趋势表明外固定的生存率更高，且两种方法成本相似。
