Impact of Hyperbaric Oxygen on More Advanced Wagner Grades 3 and 4 Diabetic Foot Ulcers: Matching Therapy to Specific Wound Conditions

Abstract

Objective: The goal of this research was to identify a population of diabetic foot ulcer patients who demonstrate a significant response to hyperbaric oxygen therapy (HBOT) using a large sample size to provide guidance for clinicians when treating these complicated patients. Approach: The effect of HBOT on diabetic foot ulcers, Wagner grades 3 and 4, was evaluated using a retrospective observational real-world data set. The study reported on the overall healing rate, (74.2%) at the population level, for >2 million wounds. Results: When a subgroup of patients of only foot ulcers with a Wagner grade 3 or 4 were considered, the healing rate was only 56.04%. The use of HBOT, without filtering for the number of treatments received, improved the healing rate to 60.01% overall. Healing rates for this same subgroup, however, were improved to 75.24% for patients who completed the prescribed number of hyperbaric treatments. Innovation: This observational study discusses the importance of reporting at the population level, specific wound etiology level, a risk-stratified level, and to then overlay the effect of treatment adherence on those outcomes to provide clinicians with a comprehensive understanding of when to prescribe an advanced modality such as hyperbaric oxygen. Conclusion: The authors provide healing outcomes data from several prior HBOT studies as well as other advanced modalities that have been used in diabetic foot ulcer care for comparison and context.

Keywords: Wagner grade 3 or 4; adjunctive wound therapy; advanced wound therapy; diabetic foot ulcer; hyperbaric oxygen therapy.

William J. Ennis, DO, MBA, MMM, CPE

Figure 1.

Healing Rates. mITT pop: modified intent-to-treat population level. mITT db pop: modified intent-to-treat diabetic population. wag 3/4/foot: Wagner Grade 3 or 4 on foot. wag 3/4/foot>1 HBO: Wagner Grade 3 or 4 on foot incomplete HBOT. wag 3/4/foot complete HBO: Wagner Grade 3 or 4 on foot completed HBOT treatment course. HBOT, hyperbaric oxygen therapy; mITT, modified intent-to-treat.