P67
Impact of patient compliance on healing and recurrence rates of diabetic foot ulcers
S. Coerper, S. Beckert, A. Königsrainer
Department of General- and Transplantsurgery, University Hospital Tübingen, Germany
Introduction: Risk factors for amputation or recurrence of diabetic foot lesions such as infection, ischemia or osteitis are well evaluated. However, the impact of patient compliance both on healing and recurrence rates has not yet been elucidated so far.
Materials and methods: Over the last 10 years, 520 patients with 765 diabetic foot ulcers (wagner grade 1 and 2) were treated in a specialized outpatient wound clinic according to a comprehensive wound care protocol. Healing was assessed in a prospective setting for maximum one year of treatment. Compliance was defined as appropriate handling of dressing changes and pressure offloading and was judged by physicians or nurses as good, moderate or bad. Healing and recurrence rates were calculated with Kaplan-Meier analysis, differences between groups with log-rank-test. Results are given as mean+SD.
Results: Diabetic foot ulcers were classified as neuropathic in 35%, as ischemic in 15% and as both neuropathic and ischemic in 50%. Mean ulcer duration was 243+15 days and wound area was 3,6+0,3 cm2.Within a treatment time of 208+5.5[range 3-365] days, 422 (55%) ulcers were healed, 56 by primary toe amputation (7%). Out the these 422 healed ulcers, follow-up was documented in 137 (33%) cases (mean time of follow-up 294+20[range 5-1642] days). Probability of healing was significantly reduced in infected and ischemic wounds and in wounds of elderly patients (p=0.001). Similarly, wounds of patients with bad compliance (63%) showed a significantly lower probability of healing (p=0.0001). Overall recurrence rate during follow-up was 30%, while ischemic wounds had a significantly higher recurrence rate (p=0.03). Additionally, good compliance was associated with significantly lower recurrence (p=0.02).
Conclusion: With this investigation, we were able to show for the first time that patient compliance has a significant impact on healing and recurrences rates of diabetic foot ulcers. This fact should receive more attention in future studies.