title: In-hospital mortality and length of stay in patients with diabetes having foot disease.
abstract: OBJECTIVE
  We aimed to determine whether in-patient mortality and length of stay were greater in diabetes patients with foot disease compared to those without foot disease.
  
  
  METHODS
  Retrospective data analysis of admissions over four years (2007-2010) to University Hospital Birmingham. Based on discharge diagnostic codes we grouped admissions into those 1) with amputation, 2) with foot disease and 3) without foot disease. Inpatient mortality and length of stay were compared between the three groups, adjusting for confounders.
  
  
  RESULTS
  We identified 25,118 admissions with diabetes of which 1149 admissions (4.6%) had foot disease and another 195 (0.8%) had a code for lower limb amputation. When compared to those without foot disease the adjusted odds ratio for inpatient mortality was 1.31 (95% CI 1.04-1.65 P=0.02) in the foot disease group, and 1.02 (95% CI 0.56-1.85 P=0.95) in the amputation group; and the adjusted relative ratio for length of stay was 2.01 (95 CI 1.86-2.16 P<0.001) in the foot disease group and 3.08 (95% CI 2.60-3.65 P<0.001) in the amputation group.
  
  
  CONCLUSIONS
  Foot disease in hospitalised patients with diabetes is associated with increased length of stay and inpatient mortality. Our study adds to evidence on excess mortality associated with diabetic foot disease and to evidence on excess mortality observed in people with diabetes admitted to hospitals.
authors.affiliation: School of Health and Population Sciences, University of Birmingham, UK; ePrescribing Research Team, University Hospital Birmingham, Birmingham, UK; Institute of Digital Healthcare, University of Warwick, UK; Warwick Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals of Coventry and Warwickshire, Coventry, UK. Electronic address: k.nirantharan@bham.ac.uk.
authors.forename: Krishnarajah
authors.initials: K
authors.lastname: Nirantharakumar
authors.forename: Mujahid
authors.initials: M
authors.lastname: Saeed
authors.forename: Ian
authors.initials: I
authors.lastname: Wilson
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
authors.forename: Jamie J
authors.initials: JJ
authors.lastname: Coleman
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality* / Q000628:therapy; D017719:Diabetic Foot / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: Diabetes; Diabetic foot; Hospitals; Length of stay; Mortality