Clinical Patterns, Treatment Modalities and Outcome of Diabetic Foot Ulcers in Three Regional Hospitals in the South-West Region of Cameroon

Background: Diabetic foot ulcer (DFU) is one of the most devastating complications of diabetes mellitus. It has significant effects on patient morbidity and mortality and is a frequent cause of hospitalization and disability in diabetic patients. Objective: To describe the clinical patterns, treatment modalities and outcome of DFU in the South-west Region of Cameroon. Method: This was a multi-centered five-year retrospective study carried out in Three Regional Hospitals in the South-West Region of Cameroon. Data collected from patients medical records were entered into a structured pre-tested data entry form and analysed using Statistical Package for Social Sciences (SPSS) Version 26. Bivariate and multivariate logistic regressions were used to identify associated factors for mortality with a p-value < 0.05 considered statistically significant. Results: A total of 6760 patient records Were reviewed in the surgical departments of the three recruitment sites, 394 cases of DFU were identified (5.8% of all surgical hospitalizations) and 360 were finally retained for analysis. The most common clinical patterns were Wagner grade IV (172/360: 47.8%) and grade V (87/360: 24.2%), with about half (46.9%) located at the forefoot and (30.0%) at the hind foot. Surgery was the most frequent treatment modality with major lower limb amputations making up 48.7% of definitive treatment modalities. Over 70 patients (19.7%) developed complications, including, surgical site infections (50.7%) and pressure ulcers (26.3%). The overall mortality rate was 20.3%. An associated hypertension (p < 0.017 aOR: 2.680), and the development of surgical site infections (p < 0.001 aOR: 12.562), were significantly associated with higher in-hospital mortality. Conclusion: Advanced diabetic foot ulcers (Wagner IV and V), located principally in the forefoot are very common, and are associated with high lower extremity amputations and mortality especially in patients with comorbidities like hypertension. Timely diagnosis and prompt intervention with early identification of other comorbidities might help improve outcome.