INTRAOPERATIVE ASSESSMENT OF SURGICAL CURE ACCURATELY PREDICTS CLEAN MARGIN PATHOLOGY IN PATIENTS WITH DIABETIC FOREFOOT INFECTION

Introduction and Aim In patients with diabetic foot infections who undergo amputations, decisions regarding need for postoperative antibiotics are often based on results of clean margin pathology, which may take as long as 5-7 days to be finalized. While culture data may be available more quickly, recent studies have suggested that histopathology might be more reliable. The delay in final pathology reports contributes to prolonged length of stay, increased risk of nosocomial infection, added cost of care and contributes to patient dissatisfaction. We sought to assess whether an intraoperative assessment of surgical care by podiatrists could accurately predicted the pathologist's interpretation. Methods We created a standard note template for podiatric surgeons to include in their brief operative note in patients with diabetic foot infections undergoing forefoot amputation. They could select one of 3 options: strong suspicion of cure (no further antibiotics needed), strong suspicion for residual infection (recommend prolonged antibiotics) or uncertain (await results of pathology and culture). Patients were identified using Epic's Cogito Analytics Suite. Patients were excluded if no clean margin was sent or if bone biopsy was performed without surgical resection. It the pathology report documented osteomyelitis at the clean margin or if osteomyelitis was not clearly excluded, they were not considered to have surgical cure. We retrospectively reviewed the charts of eligible patients who underwent surgical amputation between January 1, 2025 and Feb 15, 2026, with documentation of clinical impression available. Results During the study period, the template note was used 415 times, and a total of 11 patients were excluded. Impression of surgical cure was documented in 131 unique patient surgeries and histopathologic diagnosis of cure with no acute inflammation in clean margin bone specimen was documented in 105 cases for a concordance rate for cure of 87.5%. Conclusion Patients admitted for management of diabetic foot infections often have prolonged hospitalizations. We found that the intraoperative assessment of surgical cure correlated strongly with absence of osteomyelitis on histopathology of a clean margin specimen. This finding has potential to significantly decrease length of stay and minimize unnecessary antibiotic use.