title: Outcomes Following Advanced Wound Care for Diabetic Foot Ulcers: A Canadian Study.
abstract: OBJECTIVE
  Data concerning outcomes of Canadian patients with diabetic foot ulcers (DFUs) are limited. The objectives of this study were to evaluate the healing rates and identify the predictors of poor outcomes following advanced wound care in patients presenting with DFUs.
  
  
  METHODS
  We conducted retrospective cohort study of adult patients who had DFUs and were referred to a single Canadian advanced diabetic foot and wound care centre between January 1, 2010, and December 31, 2010. The primary outcome was the healing rate at 52 weeks. The generalized estimating equation model was used to identify potential risk factors associated with delayed healing of DFUs.
  
  
  RESULTS
  Of the 40 patients for whom there were complete follow ups, 35 (87.5%) had healing of all DFUs by 52 weeks. Predictors of poor healing were the presence of chronic ulcers, ulcer sizes >1 cm2, peripheral vascular disease and multiple ulcers at first presentation. Of the patients, 7.1% required amputation, and 8.9% of patients receiving our treatment died before 52 weeks. At 52 weeks of follow up, 16 of 17 recurrent ulcers and 68 of 108 pre-existing ulcers had healed. Compared to the unadjusted healing rate of preexisting ulcers (63.0%), the unadjusted healing rate of recurrent ulcers (94.1%) was significantly higher (p=0.01).
  
  
  CONCLUSIONS
  Our findings demonstrate that patients with DFUs in Canada who receive early and continued care from specialized, outpatient, advanced wound care centres experience significantly improved rates of healing of recurrent DFUs compared to pre-existing DFUs.
authors.affiliation: The Mayer Institute, Hamilton, Ontario, Canada.
authors.forename: Ivana
authors.initials: I
authors.lastname: Roth-Albin
authors.affiliation: Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Safiah H C
authors.initials: SHC
authors.lastname: Mai
authors.affiliation: Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Biostatistics Unit, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ji
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
authors.affiliation: The Mayer Institute, Hamilton, Ontario, Canada. Electronic address: drpvmayer@themayerinstitute.ca.
authors.forename: Perry V
authors.initials: PV
authors.lastname: Mayer
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods* / Q000639:trends; D000554:Ambulatory Care Facilities / Q000639:trends; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: advanced wound care; diabetic foot ulcers; multidisciplinary care; soins des plaies complexes; soins multidisciplinaires; ulcères du pied diabétique