Mr Hakim Hor Loong Loong^1,2, Dr James Kieu^1,2

¹University Of Adelaide, Adelaide, Australia, ²Royal Adelaide Hospital, Adelaide, Australia

Abstract:

Diabetic foot burns are prevalent in diabetic patients especially those with existing neuropathy[1]. Peripheral neuropathy and diminished protective reaction to thermal insults contributes to burns deep in nature and delay presentation[1,2].

Retrospective audit was conducted at RAH Adult Burn Service, with intent of improving quality of care.

Data was collected retrospectively, with 32 diabetic adults >18 years old being admitted for foot burn injury management between 2017-2022. We identified key aspects of quality care and its impact on length of stay.

NICE recommended perioperative Blood Glucose Level (BGL) range 6-10mmol/L[3] and Australian Diabetes Society and CALHN 5-10 mmol/L[4,5]. We found 81%(26/32) of patients are not in range. Of those patients, length of stay (LOS) for surgical and conservative management average 19 and 5 days respectively and patients within recommended range average 11 and 4 days respectively. LOS reduced if BGL controlled and have endocrine input (table 1).

However, other interventions showed longer LOS possibly from more comorbidities impacting recovery/require treatment. Infection was observed in 5 uncontrolled BGL patients and 1 controlled BGL but had severe burn. Interestingly, conservative management patients regardless of BGL, the LOS was similar.

In conclusion, uncontrolled BGL perioperatively could result in increased LOS and infection. In addition, specialist intervention and more aggressive BGL management could potentially help. Thus, we recommend prospective collection of the next 50 patients due to current small sample size. Furthermore, we intend to observe if patients seen by specialist earlier in admission have demonstrable improvement in BGL control, reducing complications and LOS.

References:

[1] Momeni M, Jafarian AA, Maroufi SS, Ranjpour F, Karimi H. Diabetes and foot burns. Ann Burns Fire Disasters. 2018;31(3):181-184.

[2] Barsun, A., Sen, S., Palmieri, T. and Greenhalgh, D., 2013. A Ten-Year Review of Lower Extremity Burns in Diabetics. Journal of Burn Care & Research, 34(2), pp.255-260.

[3] 2020. Perioperative care in adults [K] Evidence review for blood glucose control management. [ebook] p.30. Available at: <https://www.nice.org.uk/guidance/ng180/evidence/k-blood-glucose-control-management-pdf-317993437910> [Accessed 13 May 2022].

[4] Australian Diabetes Society, Diabetessociety.com.au. 2022. [online] Available at: <https://diabetessociety.com.au/documents/PerioperativeDiabetesManagementGuidelinesFINALCleanJuly2012.pdf> [Accessed 13 May 2022].

[5] Wilson R, Diabetes: Management of Diabetes Pre and Postoperative for Patients Admitted on the Day of Surgery, 2022 [online] Available at: < https://centraladelaide.health.sa.gov.au/> [Accessed 11 May 2022].

Biography:

Penultimate medical student in the University of Adelaide, with prior academic training in Biomedical science at the University of Adelaide. Future medical practitioner with a keen interest in plastic surgery.