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

Queensland’s diabetic foot hospitalisation and amputation reduction:  Reducing the state of our foot hospital problem?  (#99)

Peter A Lazzarini 1 2 , Sharon R O'Rourke 3 , Anthony W Russell 4 5 , Patrick H Derhy 6 , Maarten C Kamp 7 8
  1. Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Qld, Australia
  2. School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
  3. Musculoskeletal Research Program, Griffith University, Gold Coast, Qld, Australia
  4. Department of Diabetes & Endocrinology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
  5. Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
  6. Centre for Healthcare Improvement, Queensland Health, Brisbane, Qld, Australia
  7. School of Medicine, University of Queensland, Brisbane, Qld, Australia
  8. Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, Qld, Australia

Background

Diabetes foot complications are a leading cause of amputation and avoidable hospitalisation. Since 2006, Queensland Health has implemented multiple innovative ambulatory programs targeting reductions in diabetes-related hospitalisation and amputation.  The aim of this retrospective observational study was to determine the incidence of diabetes foot-related hospitalisation and amputation in Queensland from 2005 to 2010.

Methods  

Data on all primary diabetes foot-related hospital admissions and amputation procedures in Queensland from 2005-2010 was obtained using diabetes foot-related ICD-10-AM (hospital discharge) codes.  Queensland diabetes foot-related admission and amputation incidences were calculated using data from the Australian Bureau of Statistics for general population rates and the National Diabetes Services Scheme for diabetes population rates.  Chi-squared tests were used to assess changes in admissions over time.

Results

Overall, 24,917 diabetes foot-related admissions and 4,443 amputations occurred; resulting in the use of 260,085 bed days or 1.4% of all available Queensland hospital bed days.   The incidence of diabetes foot-related hospitalisation, between 2005 and 2010, among the general population (per 100,000) reduced by 22% for admissions (103.0 in 2005, to 80.7 in 2010), 18% for amputations (18.2 to 15.0) and 18% for bed days (1,099 to 904) (p < 0.001).  Furthermore, the diabetes foot-related hospitalisation incidence among the diabetes population (per 1,000) reduced by 43% for admissions (37.9 to 21.6), 40% for amputations (6.7 to4.0) and 40% for bed days (404 to 242) (p < 0.001). 

Conclusion and Clinical Relevance   

This paper appears to be the first to report significant reductions in diabetes foot admission and amputation incidence in an Australian state.  This decrease has coincided with the implementation of several diabetes foot clinical programs throughout Queensland.  Whilst these results are encouraging in the Australian context, further efforts are required to decrease to levels reported internationally.