Audit of diabetic soft tissue infection and foot disease in Accra

Abstract

BACKGROUND: Soft tissue infection and foot disease are well known complications among diabetes mellitus patients. With an increasing prevalence of diabetes mellitus in Africa, management of these complications is expected to become a major problem. OBJECTIVE: To audit the surgical management of diabetic soft tissue infection and foot disease over a two-year period in Accra, Ghana. METHODS: A prospective study of all patients admitted to the General Surgical Unit of the 37 Military Hospital between May 2005 and April 2007 was conducted. Diabetic patients with soft tissue infections and foot disease were selected for study. Doppler studies using a monopolar 8 MHz Nicolet vascular probe was used in assessing the ankle to brachial pressure index (ABPI). Patients were managed based on admitting diagnosis and outcomes were noted. RESULTS: Eighty (8.3%) of 966 surgical patients had diabetes mellitus and soft tissue infection or foot disease. The peak age of presentation of diabetics with soft tissue infection or foot disease was 50-59 years. Diabetic foot disease (53.0%) was the commonest followed by cellulitis of the leg and other soft tissue infections. Overall amputation rate was 33.3% while mortality was 8.8%. CONCLUSION: Foot infections, cellulitis, abscesses and gangrene are the common surgical complications of diabetes mellitus patients in Ghana. Abscess of the hand is the commonest non-foot soft tissue surgical complication and had good outcomes. Overall, females presented earlier and had better outcomes than males.