Assessment and management of inpatients with acute diabetes-related foot complications: room for improvement.
BACKGROUND
Australian data are currently lacking regarding management guidance, resource usage and outcomes of patients with diabetes requiring hospitalization for management of acute foot complications.


OBJECTIVE
The aims of the present study were to review hospital admissions for diabetes-related foot complications and current assessment and management of these complications, and to formulate recommendations for future models of care.


METHODS
A retrospective review of patient records from 1 July 1999 to 30 June 2000 was carried out. Recorded assessment, investigations, management, amputation rates, referral rates and length of hospital stay were reviewed.


RESULTS
There were 69 admission episodes in 12 months (total patients n = 50). The mean age was 64 years, with 44 male patients (64%) and 25 female patients (36%). The mean diabetes duration was 11 years (range <1-47 years). The majority of patients had type 2 diabetes. Assessment for known risk factors for ulceration and amputation was variable with history of previous ulcer/amputation recorded for 24 (35%) admissions, results of neurological assessment recorded for 11 (16%) and assessment of pedal pulses documented for 51 (74%). Glycated haemoglobin was performed during 35 (51%) admissions. Patients were admitted under one of 11 different inpatient units and the average interdepartmental referral rate was one referral per patient per admission. The average length of stay was 17 days, with total bed days occupied 1163 days. Minor amputation was performed in 25 (36%) cases and major amputation in 8 (11%).


CONCLUSIONS
Clinical assessment, investigation and management of this population are highly variable. This has a significant impact on the final clinical outcome, and changes to current processes are required to overcome the substantial burden of diabetic foot disease.
Lawrence
S M
SM
The Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. shan.lawrence@mh.org.au
Wraight
P R
PR
Campbell
D A
DA
Colman
P G
PG
D000671:Amputation, Surgical; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000601:surgery*; D019468:Disease Management; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome