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-
1.
Lipsky BA , Aragón-Sánchez J & Diggle M et al.; International Working Group on the Diabetic Foot: IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 32 (suppl 1) : 45, 2016.
-
2.
Lipsky BA , Berendt AR & Deery HG et al.: Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 39 : 885, 2004.
-
3.
Jiang HJ , Stryer D & Friedman B et al.: Multiple hospitalizations for patients with diabetes. Diabetes Care 26 : 1421, 2003.
-
4.
Lipsky BA , Berendt AR & Cornia PB et al.: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 54 : e132, 2012.
-
5.
Lipsky BA , Armstrong DG & Citron DM et al.: Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial. Lancet 366 : 1695, 2005.
-
6.
Han SM , Wu B & Eichler CM et al.: Risk factors for 30-day hospital readmission in patients undergoing treatment for peripheral arterial disease. Vasc Endovasc Surg 49 : 69, 2015.
-
7.
Ries Z , Rungprai C & Harpole B et al.: Incidence, risk factors, and causes for thirty-day unplanned readmissions following primary lower extremity amputation in patients with diabetes. J Bone Joint Surg Am 97 : 1774, 2015.
-
8.
Ang C & Lim Y: Recurrent admissions for diabetic foot complications. Malays Orthop J 7 : 21, 2013.
-
9.
Lipsky BA , Sheehan P & Armstrong DG: Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial. Int Wound J 4 : 30, 2007.
-
10.
Tan JS , Friedman NM & Hazelton-Miller C et al.: Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation? Clin Infect Dis 23 : 286, 1996.
-
11.
Wukich DK , Hobizal KB & Brooks MM: Severity of diabetic foot infection and rate of limb salvage. Foot Ankle Int 34 : 351, 2013.
-
12.
Barshes NR , Mindru C & Ashong C et al.: Treatment failure and leg amputation among patients with foot osteomyelitis. Int J Low Extrem Wounds 15 : 303, 2016.
Risk Factors Associated with 30-Day Readmission in Patients with Diabetic Foot Infections
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Background
Diabetic foot infections (DFIs) are the most common cause of hospitalization for patients with diabetes. Studies have shown diabetic patients have high readmission rates. It is important to identify variables that contribute to readmission. This study aimed to investigate clinical variables associated with 30-day hospital readmission in patients with DFI.
Methods
We conducted a retrospective study of adults admitted to the hospital for DFI between July 1, 2012, and July 1, 2015. We identified patients by International Classification of Diseases, Ninth Revision codes and randomly selected 35% of medical records for review. Patients were excluded if they did not have a DFI by review, were pregnant, or were incarcerated. The primary outcome was 30-day readmission. Data collected included baseline demographics, medical comorbidities, substance abuse, homelessness, tobacco use, and laboratory and surgical pathology data. Univariate and multivariate logistic regression models were used to identify independent predictors.
Results
Of 140 included patients, 106 (76%) were male. Median age was 55 years and length of stay (LOS) was 7 days. In univariate analysis, 31 patients (22%) were readmitted in the 30 days after the index hospitalization. Factors associated with readmission included treatment failure, elevated C-reactive protein level, and hospital LOS (P < .05). In multivariate analyses, LOS and treatment failure were independent predictors of readmission.
Conclusions
The 30-day readmission rate for patients with DFI is high. Treatment failure, C-reactive protein, and LOS are independently associated with readmission. More work is needed to determine reasons for readmission so that appropriate measures can be taken before discharge.
Department of Medicine, Denver Health Medical Center, Denver, CO.
Denver Health Medical Center, Denver, CO.
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