Decreasing Incidence of Major Amputation in Diabetic Patients: a Consequence of a Multidisciplinary Foot Care Team Approach?

TLDR

The study retrospectively assessed whether a multidisciplinary foot‑care programme reduced diabetes‑related lower‑extremity amputations in a 0.2 million‑person population with 2.4 % diabetes prevalence. All primary amputations (toe to hip) performed between 1 January 1982 and 31 December 1993 were included in the analysis. Amputations fell from 38 to 21 per year, major‑amputation incidence dropped 78 % (16 → 3.6 per 100 000), re‑amputation rates decreased 22 % (36 → 22 %), and 71 % were ulcer‑related, indicating a sustained reduction attributable to the multidisciplinary approach.

Abstract

The purpose of this retrospective study was to evaluate the changes in diabetes‐related lower extremity amputations following the implementation of a multidisciplinary programme for prevention and treatment of diabetic foot ulcers in a 0.2 million population with a 2.4 % prevalence of diabetes. All diabetes‐related primary amputations from toe to hip from 1 January 1982 to 31 December 1993 were included. In 294 diabetic patients, 387 primary major (above the ankle) or minor (through or below the ankle) amputations were performed, constituting 48 % of all lower extremity amputations. The annual number of amputations at all levels decreased from 38 to 21, equalling a decrease of incidence from 19.1 to 9.4/100 000 inhabitants ( p = 0.001). The incidence of major amputations decreased by 78% from 16/1 to 3.6/100 000 inhabitants ( p <0.001). The absolute number of amputations with a final level below the ankle showed no increase, but their proportion increased from 28 to 53 % ( p <0.001) and the reamputation rate decreased from 36 to 22 % ( p <0.05) between the first and last 3‐year period. Thus, a substantial long‐term decrease in the incidence of major amputations was seen as well as a decrease in the total incidence of amputations in diabetic patients. Seventy‐one per cent of the amputations were precipitated by a foot ulcer. These findings indicate that a multidisciplinary approach plays an important role to reduce and maintain a low incidence of major amputations in diabetic patients