Poster Presentation The Annual Scientific Meeting of the Australian Diabetes Society and the Australian Diabetes Educators Association 2013

Rates of admission for diabetic foot ulceration, and amputation rates, 2002-2011, in the absence of a diabetes foot team (#353)

Leanne Leong 1 , Jennifer Pham 1 , Nadia Costa 2 , Duncan Topliss 1 3
  1. Dept of Endocrinology & Diabetes, The Alfred, Melbourne, VIC, Australia
  2. Health Information Services, Alfred Health, Melbourne, VIC, Australia
  3. Dept of Medicine, Monash University, Melbourne, Australia

A multidisciplinary diabetes foot team (DFT) may improve outcomes and reduce length of stay (LOS) of hospitalisation for diabetic foot ulcers but assessment of effectiveness requires knowledge of outcomes before DFT institution. We surveyed rates of hospitalisation for diabetic foot ulceration using ICD-AM codes (PE 10.69, 11.69, 13.69, 10.73, 11.73, 13.73) and lower limb amputation (ICD-AM 44367) at our institution from 2002-2011 when no DFT existed. During this period patients were admitted under vascular surgery or diabetes units but managed in consultation from multiple units, routinely including endocrinology, vascular surgery, infectious disease, and podiatry. There were 1708 admissions for diabetic foot ulcers and 208 amputations (12.2%) of which 47.1% were major. The rate of ulcer admissions increased over time (r2 = 0.58, p = 0.010) but the total amputation rate decreased (r2 = 0.55, p = 0.014) and the major amputation rate also decreased (r= 0.56, p = 0.013). Over 2002-6, of 747 ulcer admissions, 115 resulted in amputation (15.4%) of which 53.9% were major, but for 2007-2011, of 961 ulcer admissions 93 resulted in amputations (9.7%) of which 38.7% were major. LOS of patients who had amputations did not decrease over time (r2 = 0.11, p = 0.34). Over 2002-6 mean LOS was 30.5 days, and over 2007-11 was 29.2 days. We conclude that: 1. Despite absence of a DFT both overall lower limb amputation rate and major amputation rate for diabetic foot ulcers fell 2002-2011; 2. Better results may be achievable with a DFT but assessment of effectiveness of a DFT should take into account prior trends in hospital performance; 3. Improvement in outcome of patients hospitalized for diabetic ulcer are achievable even in the absence of a DFT; 4. LOS may be a more important measure to assess performance of a DFT than amputation rate.