Mohima Begum
Introduction
Diabetic foot ulceration (DFU) is associated with significant morbidity and a 2.5-fold increase in mortality. The updated 2023 International Working Group on the Diabetic Foot (IWGDF) guidelines recommend both surgical and non-surgical offloading techniques, including day-case procedures such as digital flexor tenotomies, to reduce ulcer progression. This audit evaluated adherence to the guidelines within the Diabetic Limb Salvage Service (DLSS) with a focus on surgical offloading.
Methods
A retrospective audit was conducted of patients attending the DLSS between 01/05/2023 and 01/09/2023. Data was collected on adherence to three non-surgical and two surgical IWGDF offloading recommendations. Offloading strategies, alongside patient demographics, and ulcer characteristics, infection status, and surgical interventions, were analysed. Adherence was defined as implementation of at least one recommended intervention.
Results
59 patients met the inclusion criteria (mean age 70.6 +/- 10.4 years, male:female 2.2:1). Digital ulcers were the most prevalent (n=35). Overall, 69.5% of patients received at least one offloading intervention, with a mean adherence across all IWGDF recommendations of 12.1%. Adherence to removable offloading (recommendation 2) was highest (59.3%). Adherence to both surgical recommendations was 0%. Documentation of offloading counselling was present in only 8.4% of cases.
Conclusion
Adherence to the IWGDF guidelines remains inconsistent, with underutilisation of gold-standard and surgical management techniques, including day-case procedures. Suboptimal documentation split between two IT systems further limited assessment of compliance. These findings highlighted key targets for service improvement. Since auditing, standardised electronic documentation, clerking proformas and targeted clinician education were implemented, with a re-audit underway to evaluate improvement.
Authors
Mohima Begum, Christopher Ashmore
Leeds Teaching Hospitals Trust, Leeds, United Kingdom