{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:54:22Z","timestamp":1790934862230,"version":"4.1.0"},"reference-count":17,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,10]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study analysed the clinical outcomes and healthcare costs associated with diabetic foot ulcer (DFU) within a tertiary healthcare centre in Singapore.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This is a retrospective, single-centre study. Patient data were extracted from the hospital\u2019s electronic health system, including demographic, clinical and hospitalisation information. Hospitalisation costs were categorised into DFU-related and other hospitalisation costs. A one-way sensitivity analysis was performed to estimate the total healthcare costs associated with DFU.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Tertiary centre within a population suffering from a diabetic epidemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>All patients aged 18 years or older who received DFU treatment between January 2019 and December 2023 at the Singapore General Hospital were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2857 DFU patients were included in the study. In-hospital mortality remained stable at 5%\u20136%\u2009annually. Among the cohort, 39.1% underwent minor amputations, 19.6% had major amputations and 9.0% experienced both minor and major amputations. The median length of stay for surgical patients ranged from 10 (IQR 4\u201324) to 13 days (IQR 6\u201331), compared with 4 (IQR 2\u20138) to 5 (IQR 3\u20139.5)\u2009days for non-surgical patients. Total costs per admission for patients with DFU-related surgery ranged from US$28 588.96 to US$34 204.77, while for those without surgery, costs ranged from US$6637.59 to US$7955.23. Total hospitalisation costs for DFU during the study period ranged from US$65.87\u2009million to US$72.16\u2009million. All figures were inflation adjusted to 2023 US dollars.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>DFU poses a significant clinical and economic burden in Singapore. Understanding the costs associated with DFU is essential for resource allocation and planning in DFU management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099215","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T07:20:34Z","timestamp":1759130434000},"page":"e099215","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Retrospective analysis of value-driven outcomes of diabetic foot ulcer in a tertiary hospital in Singapore"],"prefix":"10.1136","volume":"15","author":[{"given":"Adrian Choon Kwang","family":"Chia","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan En-Howe","family":"Tan","sequence":"additional","affiliation":[{"name":"Group Finance Analytics, Singapore Health Services Pte Ltd, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi Ning","family":"Tan","sequence":"additional","affiliation":[{"name":"Group Finance Analytics, Singapore Health Services Pte Ltd, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen Jing","family":"Yeo","sequence":"additional","affiliation":[{"name":"Group Finance Analytics, Singapore Health Services Pte Ltd, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Group Finance Analytics, Singapore Health Services Pte Ltd, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8606-0842","authenticated-orcid":false,"given":"Charyl Jia Qi","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwok Ann","family":"Ang","sequence":"additional","affiliation":[{"name":"Finance, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne Kit Har","family":"Au","sequence":"additional","affiliation":[{"name":"Group Finance Analytics, Singapore Health Services Pte Ltd, Singapore, Singapore"},{"name":"Finance, Regional Health System & Strategic Finance, Singapore Health Services Pte Ltd, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tze Tec","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"2025092900201414000_15.9.e099215.1","first-page":"2367","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"AD","year":"2024","journal-title":"N Engl J Med"},{"key":"2025092900201414000_15.9.e099215.2","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0043"},{"key":"2025092900201414000_15.9.e099215.3","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2176"},{"key":"2025092900201414000_15.9.e099215.4","doi-asserted-by":"crossref","first-page":"101909","DOI":"10.1016\/j.foot.2022.101909","article-title":"Health economics of diabetic foot ulcer and recent trends to accelerate treatment","volume":"52","author":"Jodheea-Jutton","year":"2022","journal-title":"Foot (Edinb)"},{"key":"2025092900201414000_15.9.e099215.5","unstructured":"Epidemiology & disease control division, policy R& SGM of H health promotion board. In: Census of Population 2020 Statistical Release 1: Demographic Characteristics, Education, Language and Religion. 2020."},{"key":"2025092900201414000_15.9.e099215.6","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1007\/s00125-021-05441-3","article-title":"Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore","volume":"64","author":"Riandini","year":"2021","journal-title":"Diabetologia"},{"key":"2025092900201414000_15.9.e099215.7","doi-asserted-by":"crossref","unstructured":"Png ME , Yoong J , Phan TP , et al . Current and future economic burden of diabetes among working-age adults in Asia: conservative estimates for Singapore from 2010-2050. BMC Public Health 2016;16. doi:10.1186\/s12889-016-2827-1","DOI":"10.1186\/s12889-016-2827-1"},{"key":"2025092900201414000_15.9.e099215.8","doi-asserted-by":"crossref","unstructured":"Ow Yong LM , Koe LWP . War on diabetes in Singapore: a policy analysis. 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