Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Do diabetic patients who undergo transtibial amputation receive adequate treatment?(2019) Beyaz, Salih; 0000-0002-5788-5116; 30946028; M-2609-2013AIMS: To determine if patients who undergo below-knee amputation (BKA) for intractable wounds caused by diabetes complications receive adequate treatment before surgery. MATERIALS AND METHODS: The study included a total of 528 patients who underwent transtibial amputation for diabetic foot. All patients were assessed on the basis of duration of preoperative treatment, HbO therapy, negative wound pressure therapy (NPWT), peripheral vascular angioplasty (PVA) treatment, wound cultures, antibiotic medications, consultations with plastic and vascular surgeons, need for hemodialysis treatment, use of anticoagulant treatment as an inpatient, and assessment of blood sugar regulation by an endocrinologist. HbA1c, BUN, Creatinine, ESR, and CRP values attained for preoperative assessment were noted. RESULTS: Eighteen patients (3.5%) received HbO therapy, 35 (67%) NPWT therapy and 347 (65.7%) anticoagulant treatment. Wound cultures were taken in 317 patients (60.5%) and 390 (73.9%) received preoperative antibiotic treatment. 45 (8.6%) patients were assessed by plastic surgeon with 22 (4.2%) subsequently undergoing surgery by the plastic surgeon. Vascular surgeons assessed 163 patients (30.9%) and performed procedures on 45 patients (8.6%). Endocrinologists assessed 316 patients (59.8%) and implemented blood sugar regulation. PVA treatment was performed in 246 patients (466%). Patients who were managed medically for more than 7 days after the initial assessment received more HbO therapy (p=0.037), anticoagulant treatment (p=0.015), IV antibiotics (0.001), blood sugar regulation attempts (p=0.001), and PVA therapy (0.001) and had more cultures taken (p=0.001). These patients also received overall more diagnostic and treatment modalities than those that received definitive surgical intervention within 7 days. CONCLUSIONS: The duration of time patients with diabetes-related foot problems who see orthopedic surgeons for longer periods of time receive more treatment modalities and are referred more often to specialists before transtibial amputation surgery. We believe that delayed presentation is one of the main obstacles prohibiting adequate treatment for these patients.Item Cost of illness among patients with diabetic foot ulcer in Turkey(2016) Oksuz, Ergun; Malhan, Simten; Sonmez, Bilge; Tekin, Rukiye Numanoglu; 0000-0002-5723-5965; 27795820; K-8238-2012AIM To evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) from the public payer's perspective in Turkey. METHODS This study was conducted focused on a time frame of one year from the public payer's perspective. Cost-of-illness (COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs. Clinical guidelines and real data specific to Turkey were used in the calculation of the direct costs. Monte Carlo Simulation was used in the study as a sensitivity analysis. RESULTS The following were calculated in DFU treatment from the public payer's perspective: The annual average per patient outpatient costs $579.5 (4.1%), imaging test costs $283.2 (2.0%), laboratory test costs $284.8 (2.0%), annual average per patient cost of intervention, rehabilitation and trainings $2291.7 (16.0%), annual average per patient cost of drugs used $2545.8 (17.8%) and annual average per patient cost of medical materials used in DFU treatment $735.0 (5.1%). The average annual per patient cost for hospital admission is $7357.4 (51.5%). The average per patient complication cost for DFU is $210.3 (1.5%). The average annual per patient cost of DFU treatment in Turkey is $14287.70. As a result of the sensitivity analysis, the standard deviation of the analysis was $5706.60 (n = 5000, mean = $14146.8, 95% CI: $13988.6-$14304.9). CONCLUSION The health expenses per person are $-PPP 1045 in 2014 in Turkey and the average annual per patient cost for DFU is 14-fold of said amount. The total health expense in 2014 in Turkey is $-PPP 80.3 billion and the total DFU cost has a 3% share in the total annual health expenses for Turkey. Hospital costs are the highest component in DFU disease costs. In order to prevent DFU, training of the patients at risk and raising consciousness in patients with diabetes mellitus (DM) will provide benefits in terms of economy. Appropriate and efficient treatment of DM is a health intervention that can prevent complications.Item Factors affecting lifespan following below-knee amputation in diabetic patients(2017) Beyaz, Salih; Guler, Umit Ozgur; Bagir, Gulay Simsek; 0000-0002-5788-5116; 0000-0002-5375-635X; 0000-0002-5375-635X; 28865844; K-8820-2019; O-7590-2017; AAJ-4844-2021Introduction: Untreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies. The present study aimed to identify parameters that can be used to estimate survival in DM patients undergoing below-knee amputations for diabetic foot problems. Materials and methods: A total of 470 patients (299 males, 171 females) with a mean age of 64.32 years who underwent below-knee amputation for diabetic foot problems between 2004 and 2014 were enrolled in the study. The length of time from the operation to time of death was recorded in days. Patient details were obtained, including age during surgery, BMI, oral antidiabetic and insulin usage, dialysis therapy history, lower extremity endovascular intervention, previous amputation at the same extremity, the need for stump revision surgery during follow-up, and above-knee amputation at the same site. Biochemical test results of pre-operative HbAl c, ESR, and levels of CRP, BUN, and creatinine were also obtained. Results: A total of 333 patients (70.9%) died and 137 (29.1%) survived post-surgery. Survival rates were 90% in the first 7 days, 84% in the first 30 days, and 64% after the first year. Patient median life expectancy post-surgery was 930 106 days. Hemodialysis treatment (p = 0.001), endovascular intervention (p = 0.04), sex (p = 0.004), age (p = 0.001), BUN level (p = 0.001), and duration of insulin use (p = 0.003) were shown to be effective predictors of mortality. Conclusions: Life expectancy is low (<3 years) in DM patients requiring below-knee amputations for untreatable foot problems. Survival could be predicted by duration of insulin use, age, sex, and renal insufficiency. Level of evidence: Level IV, Therapeutic study. (C) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.