Validation of a diabetic foot surgery classification

Abstract

The purpose of this project was to evaluate associations of increasing diabetic foot surgery stage with postoperative outcome. This project, designed as a retrospective cohort model, was conducted at three large, urban referral‐based diabetic foot clinics. The investigators abstracted medical records from 180 patients with diabetes, 76·1% male, aged 57·8 ± 11·2 years, falling equally into four classes of a previously reported diabetic foot surgery classification system. These classes included class 1 (elective), class 2 (prophylactic), class 3 (curative) and class 4 (emergency). There was a significant trend towards increasing risk of ulceration/reulceration (χ2 trend= 17·8, P= 0·0001), peri‐postoperative infection (χ2 trend= 96·9, P= 0·0001), all‐level amputation (χ2 trend= 41·7 P= 0·001) and major amputation (χ2 trend= 8·6, P= 0·003), with increasing class of foot surgery. The results of this study suggest that a non vascular foot surgery classification system including variables such as the presence or absence of neuropathy, an open wound and acute infection may be predictive of peri‐ and postoperative complications. This may assist the surgeon in better identifying risk when determining a rationale for and type of surgery in persons with diabetes.