Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit.
OBJECTIVE
To assess changes in diabetic lower-extremity amputation rates in a defined relatively static population over an 11-year period following the introduction of a multidisciplinary foot team.


METHODS
All diabetic patients with foot problems admitted to Ipswich Hospital, a large district general hospital, were identified by twice-weekly surveillance of all relevant in-patient areas and outcomes including amputations recorded.


RESULTS
The incidence of major amputations fell 62%, from 7.4 to 2.8 per 100,000 of the general population. Total amputation rates also decreased (40.3%) but to a lesser extent due to a small increase in minor amputations. Expressed as incidence per 10,000 people with diabetes, total amputations fell 70%, from 53.2 to 16.0, and major amputations fell 82%, from 36.4 to 6.7.


CONCLUSIONS
Significant reductions in total and major amputation rates occurred over the 11-year period following improvements in foot care services including multidisciplinary team work.
Krishnan
Singhan
S
Ipswich Hospital, Diabetes Center, Heath Road, Ipswich, Suffolk IP4 5PD, UK.
Nash
Fiona
F
Baker
Neil
N
Fowler
Duncan
D
Rayman
Gerry
G
D000671:Amputation, Surgical / Q000401:mortality / Q000706:statistics & numerical data*; D003133:Commission on Professional and Hospital Activities / Q000458:organization & administration; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D010348:Patient Care Team; D006113:United Kingdom / Q000453:epidemiology