Clinical and wound-related predictors for prolonged hospital stay in diabetes-related foot infections in a resource-limited setting: A retrospective cohort study

Lopez-Huamanrayme E.; Caycho-Jara A.; Roque-Quico K.; Flores F.; Tamayo C.; Alferez-Condori J.; Cordova-Huancas C. · Medwave (2025) · DOI: 10.5867/medwave.2025.11.3135

Resumen

INTRODUCTION Diabetes-related foot infections are a common cause of hospitalization and are associated with prolonged hospital stays, higher healthcare costs, and poor outcomes. However, information on clinical risk factors for prolonged hospital stay in resource-limited settings is scarce. The aim of this study was to identify clinical factors associated with prolonged hospital stay in patients hospitalized for diabetes-related foot infection. METHODS We conducted a retrospective cohort study of patients admitted with diabetes-related foot infection at Hospital Nacional Alberto Sabogal Sologuren, part of the Peruvian Social Security system, between 2020 and 2021. Clinical characteristics, wound features, and treatment types were collected from electronic medical records. Prolonged hospital stay was defined as more than 10 days according to national guidelines. Associations with prolonged hospital stay were assessed using Poisson regression with robust variance. RESULTS A total of 228 patients were included (76.3% male; median age: 66 years). The most frequent comorbidities were atherosclerotic cardiovascular disease (56.6%), arterial hypertension (54.8%), and chronic kidney disease (42%). Overall, 50.5% of patients were treated with bedside wound debridement; 25.4% underwent minor amputation; and 24.1% received surgical management (major amputation or operating-room debridement). Prolonged hospital stay occurred in 49.6% of patients. Independent risk factors included wound length >5 cm (adjusted relative risk: 1.63; 95% confidence interval: 1.17 to 2.26), surgical management (1.63; 1.40 to 2.97), minor amputation (1.63; 1.22 to 2.63), and a history of atherosclerotic cardiovascular disease (1.63; 1.08 to 1.84). CONCLUSIONS Nearly half of patients with diabetes-related foot infection experienced prolonged hospital stay. Larger wound size, surgical treatment, minor amputation, and atherosclerotic cardiovascular disease were associated with prolonged hospitalization. Identifying these factors may guide clinical decisions to reduce hospital stays in resource-limited health systems.