title: The economic impact of hospitalization for diabetic foot infections in a Caribbean nation.
abstract: BACKGROUND
  Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean.
  
  
  OBJECTIVE
  To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation.
  
  
  METHODS
  We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections.
  
  
  RESULTS
  There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US $13,922,178 (mean, US $31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital.
  
  
  CONCLUSIONS
  Each year, the government of Trinidad and Tobago spends US $85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.
authors.affiliation: Senior Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in Port of Spain, Trinidad and Tobago. socawich@hotmail.com.
authors.forename: Shamir O
authors.initials: SO
authors.lastname: Cawich
authors.affiliation: Senior Resident in the Department of Surgery at San Fernando General Hospital in San Fernando, Trinidad and Tobago. sssl201198@yahoo.com.
authors.forename: Shariful
authors.initials: S
authors.lastname: Islam
authors.affiliation: Professor of Anesthesia in the Department of Clinical Surgical Sciences at the University of West Indies St Augustine Campus in Trinidad and Tobago. uwihari@gmail.com.
authors.forename: Seetharaman
authors.initials: S
authors.lastname: Hariharan
authors.affiliation: Lecturer in the Department of Surgery at the University of West Indies in San Fernando, Trinidad and Tobago. patrick_harnarayan@hotmail.com.
authors.forename: Patrick
authors.initials: P
authors.lastname: Harnarayan
authors.affiliation: Lecturer in the Department of Surgery at the University of West Indies in San Fernando, Trinidad and Tobago. stevebud@tstt.net.tt.
authors.forename: Steve
authors.initials: S
authors.lastname: Budhooram
authors.affiliation: House Officer in the Department of Clinical Surgical Sciences at the University of West Indies St Augustine Campus in Trinidad and Tobago. ssramsewak@hotmail.com.
authors.forename: Shivaa
authors.initials: S
authors.lastname: Ramsewak
authors.affiliation: Professor of Surgery in the Department of Surgery at the University of West Indies in Port of Spain, Trinidad and Tobago. vnaraynsingh@gmail.com.
authors.forename: Vijay
authors.initials: V
authors.lastname: Naraynsingh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000097:blood / Q000191:economics* / Q000628:therapy; D005260:Female; D005534:Foot Diseases / Q000191:economics* / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014300:Trinidad and Tobago; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human