Retrospective analysis of value-driven outcomes of diabetic foot ulcer in a tertiary hospital in Singapore
Andrew Chia, Ivan En‐Howe Tan, Z. Tan, W. Yeo, Yun Zhao, Charyl Jia Qi Yap, Kwok Ann Ang, Marianne Kit Har Au, Tze Tec Chong
Abstract
OBJECTIVE: This study analysed the clinical outcomes and healthcare costs associated with diabetic foot ulcer (DFU) within a tertiary healthcare centre in Singapore. DESIGN: This is a retrospective, single-centre study. Patient data were extracted from the hospital's electronic health system, including demographic, clinical and hospitalisation information. Hospitalisation costs were categorised into DFU-related and other hospitalisation costs. A one-way sensitivity analysis was performed to estimate the total healthcare costs associated with DFU. SETTING: Tertiary centre within a population suffering from a diabetic epidemic. PARTICIPANTS: All patients aged 18 years or older who received DFU treatment between January 2019 and December 2023 at the Singapore General Hospital were included. RESULTS: A total of 2857 DFU patients were included in the study. In-hospital mortality remained stable at 5%-6% annually. Among the cohort, 39.1% underwent minor amputations, 19.6% had major amputations and 9.0% experienced both minor and major amputations. The median length of stay for surgical patients ranged from 10 (IQR 4-24) to 13 days (IQR 6-31), compared with 4 (IQR 2-8) to 5 (IQR 3-9.5) days for non-surgical patients. Total costs per admission for patients with DFU-related surgery ranged from US$28 588.96 to US$34 204.77, while for those without surgery, costs ranged from US$6637.59 to US$7955.23. Total hospitalisation costs for DFU during the study period ranged from US$65.87 million to US$72.16 million. All figures were inflation adjusted to 2023 US dollars. CONCLUSIONS: DFU poses a significant clinical and economic burden in Singapore. Understanding the costs associated with DFU is essential for resource allocation and planning in DFU management.