Reduction in diabetic amputations over 15 years in a defined Spain population. Benefits of a critical pathway approach and multidisciplinary team work

• Published in: Revista española de quimioterapia Vol. 27; no. 3; pp. 170 - 179
• Main Authors: Martínez-Gómez, D A, Moreno-Carrillo, M A, Campillo-Soto, A, Carrillo-García, A, Aguayo-Albasini, J L
• Format: Journal Article
• Language: English
• Published: Spain 01-09-2014
• Subjects: Adult; Aged; Aged, 80 and over; Amputation - statistics & numerical data; Critical Pathways; Diabetes Complications - epidemiology; Diabetes Complications - nursing; Diabetes Complications - surgery; Diabetic Foot - surgery; Diet, Diabetic; Female; Humans; Lower Extremity - surgery; Male; Middle Aged; Outpatients; Patient Care Team; Sex Factors; Spain - epidemiology; Spain
• ISSN: 1988-9518

To assess changes in diabetic lower-extremity amputations (LEA) rates in a defined population over a 15-year period, following a multidisciplinary approach including a critical pathway in an inpatient setting with standardized preoperative and postoperative care, as well as in an outpatient setting through the establishment of a diabetic foot clinic.
This is a study of the incidence and types of LEAs performed in patients with diabetic foot disease complicated admitted to Morales Meseguer Hospital (Murcia, Spain), a large district general hospital, before (1998-2000) and after (2001-2012) of the introduction of better organized diabetes foot care. Hospital and clinic characteristics to the success of the programme are described. All cases of LEA in diabetic patients (1998-2012) within the area were identified by ICD-9-Clinical modification (CM) diagnostic codes. A chi square test was used to compare the frequency and level of amputations.
Over all inpatients with diabetes admitted with foot infections and gangrene, there was a significant decrease in the proportion of total major amputations (47%) and elective major amputations (66%) (p<0.001). The incidence of total major amputations rates per 100.000 of the general population fell with statistical significance (p=0.009). The biggest improvement in LEA incidence was seen in the reduction of major elective amputation with fell 60%, from 7.6 to 3.1 per 100,000 (p<0.001).
Significant reductions in total and major amputations rates occurred over the 15-year period following improvements in foot care services included multidisciplinary teamwork (critical pathway and diabetic foot clinic).