Effectiveness of fast-track pathway for diabetic foot ulcerations

Marco Meloni,Víctor Rodriguez-Saenz De Buruaga,Michela Di Venanzio,Claas Lüedemann,Jérôme Guillaumat,Juan Pedro Sánchez-Ríos,Anna Rita Aleandri,Julien Vouillarmet,José Luis García-Klepzig ,Elisabetta Iacopi,Benjamin Bouillet,José Luis Lázaro‐Martínez ,Raju Ahluwalia,Kristien Van Acker,Alberto Piaggesi,M Edmonds ,Laura Giurato,Valentina Izzo,Chris Manu,Luigi Uccioli

doi:10.1007/s00592-021-01721-x

Abstract

AimTo investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation.MethodsThe study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months.ResultsTwo hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization.ConclusionAfter the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.

Highlights

Delayed referral of persons with diabetic foot ulceration (DFU) to specialised diabetic foot services (DFS) is still a common concern around the world
Health care providers working in primary care, mainly general practitioners (GPs), reported that in 40% of case they are not adequately trained in the management of DFUs [2]
This study aims to evaluate the efficacy of fast-track pathway (FTP) implementation at a regional level, in a developed country with what is considered to be a mature DFS, and its effect on patients presenting with Diabetic Foot Disease and their primary outcomes

Summary

Introduction

Delayed referral of persons with diabetic foot ulceration (DFU) to specialised diabetic foot services (DFS) is still a common concern around the world. Health care providers working in primary care, mainly general practitioners (GPs), reported that in 40% of case they are not adequately trained in the management of DFUs [2]. Due to this current issue, International Diabetic Foot Care Group (IDFCG) and D-Foot International developed an easyto-use tool, called fast-track pathway (FTP) for DFU, addressed to not-expert health care professionals (HCPs) and aiming to detect ulcer’ severity, the specific management and timing of referral [3]. It has gained national and regional recognition and was presented at local meetings to HCPs working in primary care such as GPs, district nurses, and in other settings such as diabetologists, podiatrist, vascular & orthopaedic surgeons, interventional radiologists/cardiologists among others

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