EARLY VERSUS LATE WOUND DEBRIDEMENT IN THE MANAGEMENT OF DIABETIC FOOT ULCERS AT A TERTIARY CARE TEACHING HOSPITAL IN SOUTH INDIA: A RETROSPECTIVE COMPARATIVE COHORT STUDY

Abstract

Background: Diabetic foot ulcers (DFUs) are a major source of morbidity in patients with diabetes, and surgical debridement of infected or necrotic tissue is a cornerstone of their management. While the principle of source control is well established, the effect of debridement timing — early versus late — on clinical outcomes has been little studied in Indian tertiary care settings. This study compared outcomes between patients undergoing early (within 48 hours of admission) and late (after 48 hours) surgical debridement for infected DFUs. Methods: We conducted a retrospective comparative cohort study of 100 patients admitted with infected diabetic foot ulcers at a tertiary care teaching hospital in Chennai, Tamil Nadu, India, between January 2023 and January 2025. Patients were divided into an early debridement group (Group A, n=50) and a late debridement group (Group B, n=50). Adults over 18 years with type 2 diabetes and clinical and/or radiological evidence of infected foot ulcer who received surgical debridement during hospitalisation were included. Descriptive statistics, the chi-square test, independent t-test, and multivariate logistic regression were used for analysis (SPSS v25; p<0.05 considered significant). Results: The cohort had a mean age of 60.4 ± 10.2 years (65% male) and mean diabetes duration of 8.7 ± 4.1 years; comorbidities included hypertension (52%), coronary artery disease (14%), and chronic kidney disease (10%). All ulcers were Wagner grade 2 or higher. Compared with Group B, Group A had a shorter mean hospital stay (7.2 ± 2.1 vs 10.5 ± 3.4 days; reduction of 3.3 days, p<0.001), a lower post-debridement infection rate (18% vs 34%), a higher healing rate (84% vs 66%, p=0.01), and a lower treatment failure rate (10% vs 20%). Early debridement independently predicted healing success on multivariate logistic regression (odds ratio 2.8; 95% confidence interval 1.4–5.7; p=0.004), and the amputation rate was significantly lower in Group A (p=0.02). Conclusion: In this cohort, early surgical debridement (within 48 hours of admission) of infected diabetic foot ulcers was associated with improved healing, reduced treatment failure and amputation, and shorter hospital stay compared with late debridement. These findings support prioritising prompt surgical source control in diabetic foot infection, pending confirmation in larger prospective multicentre studies.