The Efficacy of Diabetic Foot Treatment in a “TOSF” Pattern: A Five-Year Retrospective Study

Aim: To evaluate the advantages and problems in the diagnosis and treatment of diabetic foot (DF) patients by analyzing the results of a 5-year follow-up of the organ system based (TOSF) treatment model.Methods: A retrospective study was conducted in 229 patients with diabetic foot.Chi-square test and rank-sum test were used to analyze the effects of patients' general condition, behavioral and nutritional status, degree of infection (inflammatory markers), comorbidity, diabetic foot grade/classification, and revascularization on readmission rate, amputation rate, all-cause mortality, incidence of other complications, and wound healing time.Logistic regression was used to analyze the risk factors affecting the prognosis of diabetic foot.Kaplan-Meier survival curve was used to analyze the differences in amputation rate and mortality rate at each time point.Results: This study showed that nutritional status, degree of infection, and revascularization influenced readmission rates.General condition, behavior and nutritional status, degree of infection, Wagner grade and revascularization affect the amputation rate.General conditions, behavioral and nutritional status, degree of infection, comorbidities, classification and revascularization affect the mortality of patients.Age and white blood cell(WBC) count affected the incidence of other complications.Influence of infection degree and Wagner grade and revascularization in patients with wound healing time.Revascularization was an independent protective factor for readmission, amputation, and mortality.Elevated serum inflammatory markers are an independent risk factor for amputation.Hypoproteinemia is an independent risk factor for mortality. Conclusion:In the "TOSF" diagnosis and treatment pattern, diabetic foot patients have a good prognosis.Special attention should be paid to the screening and revascularization of lower extremity vascular disease in patients with diabetic foot.Keywords: diabetic foot, organ system, revascularization Diabetic foot(DF) is a refractory disease with a high global incidence and has become a serious public health problem.There are globally more than 463 million diabetes mellitus patients. 1The International Diabetes Federation estimates that 9.1-26.1 million diabetic patients annually will develop DF, 2 and this is the most common cause of hospitalization for diabetes, with the characteristics of a long hospitalization time, treatment difficulties, and high medical costs. 3In China, the incidence of new DF in diabetic patients within one year is 8.1%, 4 the annual amputation and mortality rates are 5.1% and 14.4%, respectively, 4 and the annual cost is 110 billion US dollars. 5There are several current traditional treatment methods for diabetic foot ulcers (DFUs), such as conventional wound therapeutic (CWT), negative pressure wound therapy(NPWT), platelet-rich plasma gel (PRP), biological agents, skin grafts, and stem cell therapy, especially the latest method of autologous wound edge dotted fullthickness skin grafting for refractory ulcer wounds has achieved satisfactory clinical results. 6However, the treatment of DF remains challenging because patients with DF have both medical and surgical conditions, it is obvious that a single department of treatment cannot meet such complex patient needs.There have been many reports globally on the treatment of DF by multidisciplinary teams. 7,8Most of the medical staff in these teams are scattered in their own diagnosis and treatment centers, therefore, the efficiency of works may be affected to a certain extent.Since our hospital began to implement the "Taking the organ