‘I would urge all RCN members to look at the Carr report’
STEVE FORD, EDITOR
20 September, 2022 By Graham Clews
A simple and inexpensive surgical procedure for patients with diabetic foot ulcers has been found to massively improve recovery rates, slash infection rates, and save almost 90% on healthcare costs.
A preliminary study, carried out at the Salford Royal NHS Foundation Trust, produced ‘revolutionary’ results, said its lead author, who urged other diabetic multidisciplinary teams to consider the procedure.
“Although the procedure is relatively simple, its potential is revolutionary”
Adrian Heald
Around 15% of people with diabetes experience foot ulcers at some point in their lives, usually on the most weight-bearing part of the foot, noted the researchers.
As a result, these patients are responsible for around 80% of lower extremity amputations in people with diabetes.
Details of the small Salford study were presented this month at the European Association for the Study of Diabetes annual meeting in Stockholm.
Researchers reported how over two years, 19 patients with diabetic foot ulcers were offered a percutaneous procedure on their feet and carried out under local anaesthetic by an orthopaedic surgeon.
Meanwhile, a control group of 14 patients was treated with standard best medical and podiatric management.
The aim of the surgery was to adjust the mechanics of the foot to remove the pressure on the area with the ulcer to accelerate healing.
After one year of follow-up, all patients in the surgery group achieved successful ulcer resolution, with an average time of 3.3-4.5 weeks.
Three patients (36%) in the standard care group saw their ulcers resolved, with an average healing time of 20 weeks.
During follow-up, no patients in the surgery group were admitted for diabetic foot sepsis compared to seven (46%) in the usual care group.
And ulcer recurrence occurred in only two patients (10%) in the surgery group compared to 10 (66%) in the standard treatment cohort.
Similarly, amputation was more common in the usual care group (seven patients, 66%) than the surgery group (two patients, 10%). No patients in the surgery cohort died, whereas six in the standard care group died.
The researchers estimated that, compared with the average usual care cost of £9,902, the average new procedure cost was £1,211, giving average savings of £8,691 per patient – an 88% reduction in healthcare costs following the procedure.
The study authors said: “We have demonstrated significant patient benefit and cost savings for this simple intervention, which merits full evaluation in a clinical trial.
“Our study is the first within the UK to demonstrate practical and financial feasibility of simple percutaneous interventions to accelerate effective healing of mechanical forefoot ulcers for patients with diabetic neuropathy,” they said.
Lead author Dr Adrian Heald added: “We urge other diabetic multidisciplinary foot teams to explore this treatment option.”
“Although the procedure is relatively simple, its potential is revolutionary,” he said.
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