Background: Annually, there are about 10,000 hospital admissions for diabetes-related foot ulcers in Australia, with lower limb amputation a common outcome.  A multidisciplinary approach, now considered best practice, has been reported to reduce amputation rate by more than 50%.  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.