Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Diabetes-related major lower limb amputation in rural and Indigenous Western Australians – Missed opportunities for earlier intervention? (#328)

Aminath Laafira 1 , Seng Khee Gan 1 2 , Gerard T Chew 1 2 , Nishath Altaf 3
  1. Diabetes and Endocrinology, Royal Perth Hospital, Perth, WA, Australia
  2. School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
  3. Vascular Surgery, Royal Perth Hospital, Perth, WA, Australia

Background: Annually, there are about 10,000 hospital admissions for diabetes-related foot ulcers in Australia, with lower limb amputation a common outcome. [1] A multidisciplinary approach, now considered best practice, has been reported to reduce amputation rate by more than 50%. [2] The Royal Perth Hospital (RPH) multidisciplinary foot ulcer clinic (MDFUC) has been operational since 2004.

Aim: To determine whether diabetic patients who underwent a major lower limb amputation had prior contact with the RPH MDFUC.

Methods: We undertook retrospective clinical record analysis of diabetic patients who underwent major (ie. "above", "through" or "below knee") non-traumatic lower limb amputation at RPH between December 2012 and December 2015. We checked electronic appointment records to identify any antecedent consultations at the MDFUC.

Results: Thirty six diabetic patients had major lower limb amputation during the audit period, but only five patients (14%) were reviewed at the MDFUC prior to their amputation (three patients (8%) were seen more than 18 months prior to their amputation). Fifteen patients (42%) had been transferred from rural hospitals. Twelve patients (33%) were Indigenous Australians.

Conclusions: Most diabetic patients who underwent major lower limb amputation had not been reviewed in the MDFUC prior to their amputation. A significant proportion of lower limb amputations occurred in Indigenous Australians and in those living in rural areas. Rural and Indigenous Australians remain at high risk of limb loss from diabetes-related foot disease. Improved referral and access to multidisciplinary foot care and assessment could be opportunities to reduce major lower limb amputations in these at-risk patient groups.

  1. Australian Institute of Health and Welfare. Diabetes: Australian facts 2008. Canberra: AIHW, 2008.
  2. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev. 2000;16(Suppl 1):S75–83.