Impact of pre-hospital delays on the prognosis of older patients with diabetic foot ulcers: a 10-year retrospective study.
Journal of wound care · 2025-04-01 · Observational study
Abstract
OBJECTIVE: This study aimed to evaluate the impact of pre-hospital delay on the prognosis of older patients with diabetic foot ulcers (DFUs). METHOD: In this 10-year retrospective study, enrolled patients were divided into three groups based on the number of days before admission to hospital: <7 days (Group 1); 7-14 days (Group 2); and >14 days (Group 3). Electronic medical data were gathered, including: independent variables (such as age, sex, body mass index, education level and duration of diabetes); and dependent variables (such as number of surgeries, therapeutic regimen, Wagner grade, white blood cell counts, length of hospital stay (LoS), outcomes and treatment costs). RESULTS: A total of 288 patients were included in the study, 192 of whom were male, and the median age was 65 years. Of the studied participants, 27 arrived at the hospital within seven days, while 223 arrived after >14 days since the onset of their DFU. Significant differences were observed in the distribution of age (p=0.03) among the three groups, with the age of Group 1 lower than that of Group 3 (p=0.02). Significant differences in the distribution of number of surgeries (p=0.01), LoS (p=0.04), outcomes (p=0.04) and costs (p=0.03) were also observed among the three groups. Analyses showed that Group 1 LoS was lower than that of Group 2 (p=0.02); the number of surgeries in Group 1 was lower than that of Group 2 (p<0.01) and Group 3 (p<0.01); and Group 1 costs were lower than those of Group 2 (p=0.03) and Group 3 (p=0.03). A positive relationship was observed between pre-hospital delay and Wagner grade (0.122; p=0.04), and a positive relationship was observed between Wagner grade and LoS (0.181; p<0.01), outcomes (0.294; p<0.01), and costs (0.289; p<0.01). CONCLUSION: The findings of this study showed that longer pre-hospital delays adversely affected outcomes, such as extended hospital stays, increased numbers of surgeries and elevated hospitalisation expenses, in patients with DFUs. Age may be an underlying factor for this; further study with an increased sample size and comprehensive data is warranted.