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Otto GH, Buyukcakir C, Fife CE. Effects of smoking on cost and duration of hyperbaric oxygen therapy for diabetic patients with non-healing wounds. Undersea Hyper Med 2000; 27(2):83-89.-During this study to determine the effects of smoking on diabetic patients undergoing hyperbaric oxygen therapy (HBO^sub 2^T) for nonhealing wounds, one physician visited five hyperbaric facilities and reviewed records on 1,006 patients who had received HBO^sub 2^T for diabetic wounds. Smoking history was documented on 469 patients, while 180 patients had complete information on number of HBO2^sub 2^Ts, outcome, age, duration of diabetes, transcutaneous oxygen baseline in air at ambient conditions, Wagner score of the worst wound, smoking history, and intensity of treatment. These factors were statistically significant predictors of treatment outcome using multiple regression modeling. No difference was found between smokers with less than 10 packyears of cumulative history and nonsmokers. After that point there was a significant increase in the number of HBO^sub 2^Ts needed to produce at least some healing in smokers vs. patients who had never smoked. The average patient with a greater than 10 pack-year smoking history who benefited from treatment was estimated to need between 8 and 14 more HBO^sub 2^Ts. This translates into an added treatment cost of $4,000 to $7,000 for the average patient who has smoked, and an estimated $22-37 million annually for the United States.
diabetes mellitus, transcutaneous oxygen, Wagner score, multiple regression modeling, chronic wounds
The negative effects of persistent smoking on wound healing are well known (1-3). A variety of mechanisms are postulated, including the potential vasoconstrictive effects of nicotine. The relationship between long-term smoking and the development of vascular disease is also well recognized (4,5). Diabetics may be especially vulnerable to both acute and long-term effects of smoking on wound healing (2,6). In a recent study (7), the outcome of diabetic patients undergoing hyperbaric oxygen treatment (HBO^sub 2^T) for non-healing lower extremity wounds was found to be significantly related to smoking history. The purpose of this paper is to fir delineate the effects of smoking history on HBO^sub 2^T programs and the attendant cost of care. The costs associated with rehabilitation and loss of functionality home by the patient are not addressed.
METHODS
This study is a subset of a larger outcome...