Among patients with diabetic foot ulcers undergoing soft tissue reconstruction, 31.8% were readmitted within 90 days, with postoperative infection as the most prevalent cause and chronic kidney disease and congestive heart failure identified as independent risk factors for readmission.
Key Findings
Results
Nearly one-third of patients with diabetic foot ulcers undergoing soft tissue reconstruction were readmitted within 90 days of index admission.
Total study population was 4,325 patients identified from the US Healthcare Cost and Utilization Project's Nationwide Readmissions Database (2016-2017)
The 90-day readmission rate was 31.8%
Patients were identified retrospectively using ICD-10 codes for skin grafting, local flap, or free tissue transfer procedures for DFUs
Data source covered adult patients across the United States
Results
Surgical complications were the most common primary diagnosis category during readmission, with postoperative infection being the most prevalent specific cause.
Complications following surgical intervention accounted for 21.8% of readmission indications
Of all complication types, postoperative infection was the most prevalent cause of readmission
Primary diagnoses during readmission were categorized based on aetiology and affected organ systems
This finding highlights infectious complications as a key target for post-discharge management strategies
Results
Chronic kidney disease (CKD) was identified as an independent risk factor for 90-day readmission in multivariable analysis.
Adjusted odds ratio (aOR) for CKD = 1.31
p = 0.012
Finding was derived from multivariable logistic regression analysis controlling for other covariates
Both univariable and multivariable logistic regression analyses were performed
Results
Congestive heart failure (CHF) was identified as an independent risk factor for 90-day readmission with a stronger association than CKD.
Adjusted odds ratio (aOR) for CHF = 1.58
p < 0.001
CHF showed a larger effect size compared to CKD (aOR 1.58 vs. 1.31)
Finding was derived from multivariable logistic regression analysis
Methods
The study used a large nationally representative database to retrospectively analyze readmission patterns following soft tissue reconstruction for diabetic foot ulcers.
Data were drawn from the US Healthcare Cost and Utilization Project's Nationwide Readmissions Database for 2016-2017
Procedures included skin grafting, local flap, and free tissue transfer
Patients were identified using International Classification of Diseases (ICD)-10 codes
The study included 4,325 adult patients meeting inclusion criteria
Both univariable and multivariable logistic regression analyses were performed to identify independent risk factors
What This Means
This research suggests that patients with diabetic foot ulcers (DFUs) who undergo surgical procedures to reconstruct damaged soft tissue face a high risk of being hospitalized again within three months. Looking at data from thousands of patients across the United States, researchers found that nearly 1 in 3 patients (31.8%) were readmitted to the hospital within 90 days of their original surgery. The most common reason for these return hospitalizations was complications from the surgery itself, particularly infections at the surgical site.
The study also identified two underlying health conditions that significantly increased the likelihood of readmission: chronic kidney disease (CKD) and congestive heart failure (CHF). Patients with CHF were 58% more likely to be readmitted, and those with CKD were 31% more likely, compared to patients without these conditions. These findings suggest that patients with these comorbidities need particularly close monitoring and care coordination after their foot surgery.
This research suggests that improving outcomes for this patient population may require a team-based approach to care, including close outpatient follow-up after surgery, targeted antibiotic strategies to prevent infections, and careful management of conditions like kidney disease and heart failure before and after the procedure. Given that lower extremity amputations carry significant health and economic burdens, identifying and addressing these risk factors could help keep patients healthier and reduce costly hospital readmissions.
Suresh R, Hicks C, Haut E, You B, Caffrey J, Cooney D, et al.. (2026). Readmissions within 90 days in patients with diabetic foot ulcers undergoing soft tissue reconstruction: risk factor analysis.. Journal of wound care. https://doi.org/10.12968/jowc.2024.0225