Type 2 diabetes

Hospitalisations and amputations: study reveals disease burden with diabetes foot ulcers

Diabetic foot ulcers are associated with significant morbidity, lengthy hospital admissions and readmissions, and mortality, Australian research shows.

A retrospective study examined 564 Victorian hospital admissions between 2016 and 2018 from 338 patients with diabetic foot ulcers as the major presenting diagnosis.

The results, published in Diabetes Research and Clinical Practice, showed that 50% of ulcers were managed conservatively, 44% resulted in a minor amputation and 6.2% resulted in a major amputation.

Of those treated conservatively on their first admission, 40% were readmitted at least once and often requiring surgery.

Similarly, 34% of patients readmitted after a minor amputation and 23% of patients readmitted after a major amputation required further surgery.

The study found the absence of neuropathy, retinopathy, infection and peripheral vascular disease was associated with a lower risk of amputations.

The median length of hospital stay was 8 days with conservative management, 10 days for minor surgery and 18 days for major amputations, with these patients often requiring a separate inpatient rehabilitation admission.

Researchers from the Department of Endocrinology, Alfred Hospital, said there was a traditional concern that conservative management required prolonged admission that may ultimately fail leading to subsequent amputation.

“It is therefore comforting that we found that conservative management was associated with shorter length of stay and no significant difference in readmissions,” they wrote.

Mortality was 16% overall and more than double that in patients with major amputations (38%). Only three deaths occurred within 30 days of admission – all in the conservatively treated patient group.

“Subsequent multivariate analysis showed that major amputation (HR 2.84 (1.23-6.56), p=0.014) and age (HR 1.03 (1.00-1.05), p=0.045) both remained independently associated with mortality,” the study authors said.

“Given its time course in this patient cohort, mortality is unlikely to reflect surgical complications but rather the overall health of those patients undergoing major amputations.”

The researchers said their findings supported current recommendations for the early identification and multi-disciplinary management of diabetic foot ulcers.

“The high prevalence of microvascular and macrovascular complications in this patient group emphasise the need to optimally manage these conditions, and an acute ulcer admission may be an opportunity to facilitate this.”

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