Surgical Management of Severe Lower-Limb Infections in Patients with Diabetes at Toamasina University Hospital, Madagascar: A Retrospective Study During the COVID-19 and Post-Lockdown Period

Introduction: Severe lower-limb infections in patients with diabetes are medico-surgical emergencies. During the COVID-19 period and its immediate aftermath, continuity of chronic care was weakened, which may have contributed to delayed consultations, treatment interruptions, and advanced clinical presentations.

Objective: To describe the clinical, therapeutic, and in-hospital outcomes of patients with diabetes who underwent surgical management for severe lower-limb infection in the Orthopedic Surgery Department of Toamasina University Hospital, Madagascar.

Methods: We conducted a retrospective descriptive and analytical study at Toamasina University Hospital from January 1, 2020, to June 30, 2021. Among 356 orthopedic admissions recorded during this period, 18 patients with diabetes who underwent surgery for severe lower-limb infection were included. Demographic, diabetological, clinical, microbiological, surgical, and outcome data were analyzed.

Results: Included patients represented 5.1% of admissions during the study period. The mean age was 66.9 ± 10.4 years, with a slight male predominance (55.6%). Type 2 diabetes was predominant (77.8%). The mean HbA1c was 10.24 ± 1.57%. Therapeutic non-adherence was found in 13 patients (72.2%), and delayed diagnosis in 14 patients (77.8%). The median time to consultation was 28 days. Seven patients had osteitis, six had deep soft-tissue infection, and nine required amputation. Two in-hospital deaths were recorded. Hospital stay was longer among amputated than non-amputated patients (30.3 versus 21.0 days; p = 0.027).

Conclusion: The COVID-19 and post-lockdown period appears to have magnified pre-existing weaknesses in diabetic care pathways: late access to care, irregular follow-up, and difficulty maintaining continuous foot prevention. In this context, the response cannot be surgical alone; it requires a rapid, clear, and multidisciplinary organization.