title: Analyzing treatment aggressiveness and identifying high-risk patients in diabetic foot ulcer return to care.
abstract: Rates of diabetes and its associated comorbidities have been increasing in the United States, with diabetic foot ulcer treatment representing a large cost to the patient and healthcare system. These ulcers often result in multiple hospital admissions. This study examined readmissions following inpatient care for a diabetic foot ulcer and identified modifiable factors associated with all-cause 30-day readmissions to the inpatient or emergency department (ED) setting. We hypothesized that patients undergoing aggressive treatment would have lower 30-day readmission rates. We identified patient discharge records containing International Classification of Disease ninth revision codes for both diabetes mellitus and distal foot ulcer in the State Inpatient and Emergency Department databases from the Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project in Florida and New York, 2011-2012. All-cause 30-day return to care visits (ED or inpatient) were analyzed. Patient demographics and treatment characteristics were evaluated using univariate and multivariable regression models. The cohort included 25,911 discharges, having a mean age of 63 and an average of 3.8 comorbidities. The overall rate of return to care was 30%, and 21% of subjects underwent a toe or midfoot amputation during their index stay. The most common diagnosis codes upon readmission were diabetes mellitus (19%) and infection (13%). Patients with a toe or midfoot amputation procedure were less likely to be readmitted within 30 days (odds ratio: 0.78; 95% confidence interval: 0.73, 0.84). Presence of comorbidities, black and Hispanic ethnicities, and Medicare and Medicaid payer status were also associated with higher odds of readmission following initial hospitalization (p < 0.05). The study suggests that there are many factors that affect readmission rates for diabetic foot ulcer patients. Understanding patients at high-risk for readmission can improve counseling and treatment strategies for this fragile patient population.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Austin C
authors.initials: AC
authors.lastname: Remington
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Nicholus M
authors.initials: NM
authors.lastname: Warstadt
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Micaela A
authors.initials: MA
authors.lastname: Finnegan
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Robyn
authors.initials: R
authors.lastname: Shaffer
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Jereen Z
authors.initials: JZ
authors.lastname: Kwong
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Catherine
authors.initials: C
authors.lastname: Curtin
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D003695:Delivery of Health Care / Q000592:standards*; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D037001:Directive Counseling / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D014481:United States