{"id":"https://openalex.org/W7225417362","doi":"https://doi.org/10.1302/1358-992x.2026.11.113","title":"INTRAOPERATIVE ASSESSMENT OF SURGICAL CURE ACCURATELY PREDICTS CLEAN MARGIN PATHOLOGY IN PATIENTS WITH DIABETIC FOREFOOT INFECTION","display_name":"INTRAOPERATIVE ASSESSMENT OF SURGICAL CURE ACCURATELY PREDICTS CLEAN MARGIN PATHOLOGY IN PATIENTS WITH DIABETIC FOREFOOT INFECTION","publication_year":2026,"publication_date":"2026-11-06","ids":{"openalex":"https://openalex.org/W7225417362","doi":"https://doi.org/10.1302/1358-992x.2026.11.113"},"language":"en","primary_location":{"id":"doi:10.1302/1358-992x.2026.11.113","doi":"https://doi.org/10.1302/1358-992x.2026.11.113","is_oa":false,"landing_page_url":"https://doi.org/10.1302/1358-992x.2026.11.113","pdf_url":null,"source":{"id":"https://openalex.org/S4387287184","display_name":"Orthopaedic Proceedings","issn_l":"1358-992X","issn":["1358-992X","2049-4416"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Orthopaedic Proceedings","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5016426006","display_name":"Marjorie Golden","orcid":"https://orcid.org/0000-0003-4104-3894","observed_orcids":["https://orcid.org/0000-0003-4104-3894","https://orcid.org/0000-0002-6129-9216"]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Marjorie Golden","raw_affiliation_strings":["Yale School of Medicine, New Haven, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Yale School of Medicine, New Haven, USA","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161052277","display_name":"Stacy Adil","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1323778983","display_name":"Yale New Haven Hospital","ror":"https://ror.org/05tszed37","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1323778983","https://openalex.org/I4210117499"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Stacy Adil","raw_affiliation_strings":["Yale New Haven Hospital, New Haven, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Yale New Haven Hospital, New Haven, USA","institution_ids":["https://openalex.org/I1323778983"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5004902398","display_name":"Joseph E. Canterino","orcid":"https://orcid.org/0000-0003-3692-7521","observed_orcids":["https://orcid.org/0000-0003-3692-7521"]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Joseph Canterino","raw_affiliation_strings":["Yale School of Medicine, New Haven, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Yale School of Medicine, New Haven, USA","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5044873313","display_name":"Peter A. Blume","orcid":"https://orcid.org/0000-0002-8451-5962","observed_orcids":["https://orcid.org/0000-0002-8451-5962"]},"institutions":[{"id":"https://openalex.org/I1323778983","display_name":"Yale New Haven Hospital","ror":"https://ror.org/05tszed37","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1323778983","https://openalex.org/I4210117499"]},{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Peter Blume","raw_affiliation_strings":["Yale New Haven Hospital, New Haven, USA","Yale School of Medicine, New Haven, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Yale New Haven Hospital, New Haven, USA","institution_ids":["https://openalex.org/I1323778983"]},{"raw_affiliation_string":"Yale School of Medicine, New Haven, USA","institution_ids":["https://openalex.org/I32971472"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"108-B","issue":"SUPP_11","first_page":"113","last_page":"113"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11227","display_name":"Diabetic Foot Ulcer Assessment and Management","score":0.9945999979972839,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11227","display_name":"Diabetic Foot Ulcer Assessment and Management","score":0.9945999979972839,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11293","display_name":"Orthopedic Infections and Treatments","score":0.0027000000700354576,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10455","display_name":"Foot and Ankle Surgery","score":0.0005000000237487257,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/diabetic-foot-infection","display_name":"diabetic foot infection","score":0.9869999885559082},{"id":"https://openalex.org/keywords/forefoot-amputation","display_name":"forefoot amputation","score":0.984000027179718},{"id":"https://openalex.org/keywords/intraoperative-histopathology","display_name":"intraoperative histopathology","score":0.7390000224113464},{"id":"https://openalex.org/keywords/osteomyelitis","display_name":"osteomyelitis","score":0.9490000009536743},{"id":"https://openalex.org/keywords/postoperative-antibiotics","display_name":"postoperative antibiotics","score":0.6010000109672546},{"id":"https://openalex.org/keywords/podiatric-surgery","display_name":"podiatric surgery","score":0.8299999833106995},{"id":"https://openalex.org/keywords/length-of-hospital-stay","display_name":"length of hospital stay","score":0.6769999861717224},{"id":"https://openalex.org/keywords/nosocomial-infections","display_name":"nosocomial infections","score":0.6700000166893005}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9297999739646912},{"id":"https://openalex.org/C2908657372","wikidata":"https://www.wikidata.org/wiki/Q3393065","display_name":"Podiatrist","level":3,"score":0.8154000043869019},{"id":"https://openalex.org/C2776577363","wikidata":"https://www.wikidata.org/wiki/Q16989664","display_name":"Forefoot","level":3,"score":0.64410001039505},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.6166999936103821},{"id":"https://openalex.org/C2776204877","wikidata":"https://www.wikidata.org/wiki/Q477415","display_name":"Amputation","level":2,"score":0.5861999988555908},{"id":"https://openalex.org/C2780551157","wikidata":"https://www.wikidata.org/wiki/Q938983","display_name":"Osteomyelitis","level":2,"score":0.5792999863624573},{"id":"https://openalex.org/C2775934546","wikidata":"https://www.wikidata.org/wiki/Q179991","display_name":"Biopsy","level":2,"score":0.4666999876499176},{"id":"https://openalex.org/C152018380","wikidata":"https://www.wikidata.org/wiki/Q7554051","display_name":"Soft tissue pathology","level":3,"score":0.4133000075817108},{"id":"https://openalex.org/C2777858829","wikidata":"https://www.wikidata.org/wiki/Q52856","display_name":"Diabetic foot","level":3,"score":0.4097000062465668},{"id":"https://openalex.org/C544855455","wikidata":"https://www.wikidata.org/wiki/Q1070952","display_name":"Histopathology","level":2,"score":0.3977000117301941},{"id":"https://openalex.org/C194495517","wikidata":"https://www.wikidata.org/wiki/Q7646222","display_name":"Surgical pathology","level":2,"score":0.39089998602867126},{"id":"https://openalex.org/C549673821","wikidata":"https://www.wikidata.org/wiki/Q683455","display_name":"Anatomical pathology","level":3,"score":0.3402999937534332},{"id":"https://openalex.org/C43893838","wikidata":"https://www.wikidata.org/wiki/Q840545","display_name":"Sports medicine","level":2,"score":0.3321000039577484},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.3158000111579895},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.3100999891757965},{"id":"https://openalex.org/C61434518","wikidata":"https://www.wikidata.org/wiki/Q932510","display_name":"General surgery","level":1,"score":0.3084999918937683},{"id":"https://openalex.org/C2777238321","wikidata":"https://www.wikidata.org/wiki/Q876887","display_name":"Cellulitis","level":2,"score":0.29420000314712524},{"id":"https://openalex.org/C2778913397","wikidata":"https://www.wikidata.org/wiki/Q7646216","display_name":"Surgical margin","level":3,"score":0.2840999960899353},{"id":"https://openalex.org/C115076146","wikidata":"https://www.wikidata.org/wiki/Q1651051","display_name":"Foot (prosody)","level":2,"score":0.2833000123500824},{"id":"https://openalex.org/C2993769353","wikidata":"https://www.wikidata.org/wiki/Q7598360","display_name":"Standard of care","level":2,"score":0.28139999508857727},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.27570000290870667},{"id":"https://openalex.org/C160798450","wikidata":"https://www.wikidata.org/wiki/Q4230870","display_name":"Concordance","level":2,"score":0.27129998803138733},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2705000042915344},{"id":"https://openalex.org/C189539697","wikidata":"https://www.wikidata.org/wiki/Q1125312","display_name":"Microbiological culture","level":3,"score":0.26910001039505005},{"id":"https://openalex.org/C2781232998","wikidata":"https://www.wikidata.org/wiki/Q1433212","display_name":"Myositis","level":2,"score":0.26589998602867126},{"id":"https://openalex.org/C196762363","wikidata":"https://www.wikidata.org/wiki/Q723758","display_name":"Asepsis","level":2,"score":0.2558000087738037},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.2540999948978424},{"id":"https://openalex.org/C81182388","wikidata":"https://www.wikidata.org/wiki/Q353963","display_name":"Complication","level":2,"score":0.2535000145435333},{"id":"https://openalex.org/C150960172","wikidata":"https://www.wikidata.org/wiki/Q11865729","display_name":"Podiatry","level":3,"score":0.2533999979496002},{"id":"https://openalex.org/C2780084366","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demographics","level":2,"score":0.25110000371932983}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1302/1358-992x.2026.11.113","doi":"https://doi.org/10.1302/1358-992x.2026.11.113","is_oa":false,"landing_page_url":"https://doi.org/10.1302/1358-992x.2026.11.113","pdf_url":null,"source":{"id":"https://openalex.org/S4387287184","display_name":"Orthopaedic Proceedings","issn_l":"1358-992X","issn":["1358-992X","2049-4416"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Orthopaedic Proceedings","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9940000176429749,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2801995156","https://openalex.org/W2891646621","https://openalex.org/W4414768678","https://openalex.org/W2510855425","https://openalex.org/W1986720533","https://openalex.org/W4312219379","https://openalex.org/W2794880750","https://openalex.org/W2972495525","https://openalex.org/W2914293254","https://openalex.org/W2156998377"],"abstract_inverted_index":{"Introduction":[0],"and":[1,77,156,225,247,266,338],"Aim":[2],"In":[3],"patients":[4,119,216,252],"with":[5,120,229,271,317],"diabetic":[6,121,299],"foot":[7,122,300],"infections":[8,123,301],"who":[9,217],"undergo":[10],"amputations,":[11],"decisions":[12],"regarding":[13],"need":[14],"for":[15,108,144,285,289,296],"postoperative":[16],"antibiotics":[17,140],"are":[18],"often":[19,302],"based":[20],"on":[21,321],"results":[22,153],"of":[23,66,70,75,90,131,136,154,214,231,250,256,269,291,298,312,319,323,336],"clean":[24,171,192,276,325],"margin":[25,172,193,277,326],"pathology,":[26],"which":[27],"may":[28,41],"take":[29],"as":[30,32],"long":[31],"5-7":[33],"days":[34],"to":[35,63,79,84,111,205,332],"be":[36,42,53],"finalized.":[37],"While":[38],"culture":[39],"data":[40],"available":[43],"more":[44,54],"quickly,":[45],"recent":[46],"studies":[47],"have":[48,206,303],"suggested":[49],"that":[50,308],"histopathology":[51,322],"might":[52],"reliable.":[55],"The":[56],"delay":[57],"in":[58,113,118,261,275,282],"final":[59],"pathology":[60,155,186],"reports":[61],"contributes":[62,78],"prolonged":[64,148,304],"length":[65,335],"stay,":[67],"increased":[68],"risk":[69],"nosocomial":[71],"infection,":[72],"added":[73],"cost":[74],"care":[76,92],"patient":[80,264],"dissatisfaction.":[81],"We":[82,102,209,306],"sought":[83],"assess":[85],"whether":[86],"an":[87],"intraoperative":[88,310],"assessment":[89,311],"surgical":[91,182,207,219,257,313],"by":[93],"podiatrists":[94],"could":[95,128],"accurately":[96],"predicted":[97],"the":[98,185,191,212,237,240,309],"pathologist's":[99],"interpretation.":[100],"Methods":[101],"created":[103],"a":[104,248,286,324],"standard":[105],"note":[106,117,242],"template":[107,241],"podiatric":[109],"surgeons":[110],"include":[112],"their":[114],"brief":[115],"operative":[116],"undergoing":[124],"forefoot":[125],"amputation.":[126],"They":[127],"select":[129],"one":[130],"3":[132],"options:":[133],"strong":[134,142],"suspicion":[135,143],"cure":[137,258,270,290,314],"(no":[138],"further":[139],"needed),":[141],"residual":[145],"infection":[146],"(recommend":[147],"antibiotics)":[149],"or":[150,175,194],"uncertain":[151],"(await":[152],"culture).":[157],"Patients":[158,166,294],"were":[159,167,202,253],"identified":[160],"using":[161],"Epic's":[162],"Cogito":[163],"Analytics":[164],"Suite.":[165],"excluded":[168],"if":[169,176,195],"no":[170,272],"was":[173,179,197,243,259,280],"sent":[174],"bone":[177,278],"biopsy":[178],"performed":[180],"without":[181],"resection.":[183],"It":[184],"report":[187],"documented":[188,260,281],"osteomyelitis":[189,196,320],"at":[190],"not":[198,203],"clearly":[199],"excluded,":[200],"they":[201],"considered":[204],"cure.":[208],"retrospectively":[210],"reviewed":[211],"charts":[213],"eligible":[215],"underwent":[218],"amputation":[220],"between":[221],"January":[222],"1,":[223],"2025":[224],"Feb":[226],"15,":[227],"2026,":[228],"documentation":[230],"clinical":[232],"impression":[233],"available.":[234],"Results":[235],"During":[236],"study":[238],"period,":[239],"used":[244],"415":[245],"times,":[246],"total":[249],"11":[251],"excluded.":[254],"Impression":[255],"131":[262],"unique":[263],"surgeries":[265],"histopathologic":[267],"diagnosis":[268],"acute":[273],"inflammation":[274],"specimen":[279],"105":[283],"cases":[284],"concordance":[287],"rate":[288],"87.5%.":[292],"Conclusion":[293],"admitted":[295],"management":[297],"hospitalizations.":[305],"found":[307],"correlated":[315],"strongly":[316],"absence":[318],"specimen.":[327],"This":[328],"finding":[329],"has":[330],"potential":[331],"significantly":[333],"decrease":[334],"stay":[337],"minimize":[339],"unnecessary":[340],"antibiotic":[341],"use.":[342]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-11-07T00:00:00"}