Prognostic factors predicting ischemic wound healing following hyperbaric oxygenation therapy

Identifying patients who benefit from hyperoxygenation therapy is important, because treatment is time-consuming and involves high costs and complications (minor). Our objective was to develop a model for predicting therapy outcome based on population of patients with and without diabetes. A retrospective cohort study was carried out in a major hospital in Israel. All 385 patients treated between 1/1/1998 and 1/1/2007 for ischemic nonhealing lower extremities wounds were included. Data on medical history, demographic, transcutaneous oximetry, wounds, treatment, and outcome characteristics were collected. Eight factors were identified to optimally predict wound healing: (1) number of hyperbaric oxygenation treatments (odds ratio [OR]=1.034, p<0.001), (2) transcutaneous oximetry values at hyperbaric conditions (OR=1.001, p=0.019), (3) wound duration (OR=0.988, p=0.022), (4) absence of heart disease (OR=3.304, p<0.001), (5) being employed (OR=3.16, p=0.008), (6) low socioeconomic status (OR=2.50, p=0.004), (7a) good/partial granulation wound appearance (OR=2.73, p=0.022), (7b) wounds covered with fibrin (OR=3.16, p=0.015), and (8) absence of anemia (OR=2.13, p=0.016). The model's sensitivity is 78.7%, specificity is 62.9%, and accuracy is 71.8%. We suggest using our model as an adjunct to patients' clinical evaluation. Also, we recommend initiating hyperoxygenation therapy no later than 2 months after wound appearance.