Outcomes of an admission avoidance scheme for diabetic foot infections via OPAT

The 2019 National Diabetes Foot Care Audit shows 2.7% of patients with a diabetic foot ulcer underwent major amputation within six months and 14% died within twelve months. Our OPAT service treats such patients referred from inpatient wards and via the limb salvage clinic as an admission avoidance scheme. A review compared outcomes between these referrals and the national data.

The OPAT database identified patients referred via an inpatient ward and the clinic. Each patient was then reviewed for each of the following criteria:

1. Was the patient alive and ulcer free at 12 weeks?

2. Had the patient had a major amputation within six months?

3. Was the patient still alive after 12 months?

100 patients were reviewed; 50 referred by inpatient wards and 50 referred by the clinic as admission avoidance patients.

In both categories, 94% of patients were alive after twelve weeks, with 12% being ulcer-free in the inpatient category compared with 18% in the admission avoidance group. 6% had a major amputation within six months in the inpatient group, compared with none in the admission avoidance group. 16% of patients in the inpatient group had died within 12 months of treatment, compared with 10% of admission avoidance patients.

OPAT patients receiving treatment for diabetic foot infections have similar outcomes to those in the national audit. No extra harm is being done to those referred to OPAT without hospital admission.