(EBP-015) Meta-Analysis: Outcomes of Surgical and Medical Management of Diabetic Foot Osteomyelitis

Co-Author(s):

Roger Bedimo, MD; Dane Wukich, MD – UT Southwestern. Medical Center; Amanda Killeen, DPM – UT Southwestern Medical Center; Lawrence Lavery, DPM, MPH – UT Southwestern Medical Center

Introduction: Current treatment recommendations for DFO are often poorly supported by clinical evidence. The operational definitions to define DFO and its outcomes are inconsistent and often rely on surrogate markers, such as wound healing or ulcer recurrence that do not have a clear, direct relationship with residual bone infection. Many of the recommendations made by the Infectious Diseases Society of America and International Working Group on the Diabetic Foot are based on low levels of graded evidence. The aim is to evaluate clinical outcomes in the published literature on medical and surgical management of DFO.

Methods:

A PubMed and Google Scholar search of articles relating to DFO was performed over the dates of January 1931 to January 2020. QUADAS-2 was used to rate the bias of each study. A meta-analysis was performed using random-effects and inverse variance methods. The search yielded 1,192 articles. After reviewing and removal of articles that did not meet inclusion criteria, 28 articles remained. Eighteen articles related to the medical management of DFO and 13 articles related to surgical management. Three articles looked at a combination of medical and surgical management. Heterogeneity was evaluated using Cochran’s Q, I², τ² and τ.

Results: The average success rate for medical treatment was 68.2% (range 17.0 to 97.3%), and for surgical and medical treatment was 85.7% (range 65.0 to 98.8%).  There were significant inconsistencies in accounting for peripheral arterial disease and peripheral neuropathy.  There was significant heterogeneity in outcomes between studies. However, there was a high rate of successful treatment and a wide range between patients with medical treatment and combined surgical and medical treatment.

Discussion: Additional properly designed prospective studies with gold-standard references for diagnosing OM are needed to help determine whether medical management of DFO can be successful without surgical intervention.

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