Shamir O Cawich1, Shariful Islam2, Seetharaman Hariharan3, Patrick Harnarayan4, Steve Budhooram5, Shivaa Ramsewak6, Vijay Naraynsingh7. 1. Senior Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in Port of Spain, Trinidad and Tobago. socawich@hotmail.com. 2. Senior Resident in the Department of Surgery at San Fernando General Hospital in San Fernando, Trinidad and Tobago. sssl201198@yahoo.com. 3. Professor of Anesthesia in the Department of Clinical Surgical Sciences at the University of West Indies St Augustine Campus in Trinidad and Tobago. uwihari@gmail.com. 4. Lecturer in the Department of Surgery at the University of West Indies in San Fernando, Trinidad and Tobago. patrick_harnarayan@hotmail.com. 5. Lecturer in the Department of Surgery at the University of West Indies in San Fernando, Trinidad and Tobago. stevebud@tstt.net.tt. 6. House Officer in the Department of Clinical Surgical Sciences at the University of West Indies St Augustine Campus in Trinidad and Tobago. ssramsewak@hotmail.com. 7. Professor of Surgery in the Department of Surgery at the University of West Indies in Port of Spain, Trinidad and Tobago. vnaraynsingh@gmail.com.
Abstract
CONTEXT: Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean. OBJECTIVE: To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation. METHODS: We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections. RESULTS: There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US $13,922,178 (mean, US $31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital. CONCLUSIONS: Each year, the government of Trinidad and Tobago spends US $85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.
CONTEXT: Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean. OBJECTIVE: To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation. METHODS: We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections. RESULTS: There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US $13,922,178 (mean, US $31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital. CONCLUSIONS: Each year, the government of Trinidad and Tobago spends US $85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.
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