title: Validation of a diabetic foot surgery classification.
abstract: The purpose of this project was to evaluate associations of increasing diabetic foot surgery stage with postoperative outcome. This project, designed as a retrospective cohort model, was conducted at three large, urban referral-based diabetic foot clinics. The investigators abstracted medical records from 180 patients with diabetes, 76.1% male, aged 57.8 +/- 11.2 years, falling equally into four classes of a previously reported diabetic foot surgery classification system. These classes included class 1 (elective), class 2 (prophylactic), class 3 (curative) and class 4 (emergency). There was a significant trend towards increasing risk of ulceration/reulceration (chi2(trend) = 17.8, P = 0.0001), peri-postoperative infection (chi2(trend) = 96.9, P = 0.0001), all-level amputation (chi2(trend) = 41.7, P = 0.001) and major amputation (chi2(trend) = 8.6, P = 0.003), with increasing class of foot surgery. The results of this study suggest that a non vascular foot surgery classification system including variables such as the presence or absence of neuropathy, an open wound and acute infection may be predictive of peri- and postoperative complications. This may assist the surgeon in better identifying risk when determining a rationale for and type of surgery in persons with diabetes.
authors.affiliation: Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA. armstrong@usa.net
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Robert G
authors.initials: RG
authors.lastname: Frykberg
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Wu
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000145:classification; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000145:classification*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000145:classification*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D016896:Treatment Outcome