Readmissions within 90 days in patients with diabetic foot ulcers undergoing soft tissue reconstruction: risk factor analysis.

OBJECTIVE

Soft tissue reconstruction is crucial in mitigating morbidity, mortality and economic costs associated with lower extremity amputations in patients with diabetic foot ulcers (DFUs). This study investigated the rate, causes and risk factors of 90-day readmissions in patients who underwent soft tissue reconstruction of DFUs.

METHOD: The US Healthcare Cost and Utilization Project's Nationwide Readmissions Database was queried, from 2016-2017, to retrospectively identify all adult patients who underwent skin grafting, local flap or free tissue transfer for DFUs using International Classification of Diseases (ICD)-10 codes. The number of readmissions occurring within 90 days of index admission were estimated, and univariable and multivariable logistic regression analyses were performed to identify independent risk factors for readmission. The primary diagnosis during readmission was also captured, categorising them based on aetiology and affected organ systems to identify reasons for readmission.

RESULTS

Of the 4325 patients included in the study, 31.8% were readmitted within 90 days. The most common indication for readmission was the occurrence of complications following surgical intervention in patients with DFUs (21.8%). Of all complications, postoperative infection was the most prevalent cause of readmission. Multivariable analysis showed that chronic kidney disease (CKD; adjusted odds ratio (aOR)=1.31; p=0.012) and congestive heart failure (CHF; aOR=1.58; p<0.001) were independent risk factors for readmission.

CONCLUSION

The findings of the study underscore the importance of establishing frequent outpatient follow-up and targeted antibiotic regimens to mitigate the risk of infective complications following soft tissue reconstructive procedures in patients with DFU. A multidisciplinary approach to perioperative management of comorbid conditions such as CKD and CHF may reduce the rate of readmissions and improve patient outcomes.