Comparative Outcomes of Conservative Surgery versus Early Surgical Intervention in Diabetic Foot Ulcers

Background: Diabetic foot ulcers (DFUs) are a severe complication of diabetes, often requiring intervention. Comparing conservative treatment and early surgical intervention is essential to optimize patient outcomes.Objectives: To evaluate the effectiveness of conservative surgery and early surgical intervention in the management of DFUs and to assess the association of clinical outcomes with biomarkers such as C-reactive protein (CRP) and glycated hemoglobin (HbA1c). Methods: A comparative study was conducted at different tertiary care center in Lahore between January 2021 and October 2023. A total of 300 patients with DFUs (Wagner grade 2-4) were included, with 150 receiving conservative surgery and 150 undergoing early surgical intervention. Outcomes measured included wound healing time, revision surgeries, and amputation rates. The association of these outcomes with CRP and HbA1c levels was analyzed.Results: Patients in the conservative surgery group had a higher rate of revision surgeries (53% vs. 41%, p = 0.04) and longer hospital stays (median 20 vs. 16 days, p < 0.01). Elevated CRP levels (median 58 mg/L, IQR 15–170) were significantly associated with clinical failure (HR = 1.8, p = 0.03), as were elevated HbA1c levels (median 8.2%, IQR 7.5–9.0; HR = 1.5, p = 0.02). Early surgical intervention was linked to lower revision rates and quicker recovery but at the cost of increased limb loss. Conclusion: Conservative surgery preserves limbs but often requires revisions and longer treatment durations, while early surgery shortens recovery time but raises amputation risks. Biomarkers like CRP and HbA1c are critical for guiding personalized treatment decisions.