title: Reduction in diabetic amputations over 15 years in a defined Spain population. Benefits of a critical pathway approach and multidisciplinary team work.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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).
authors.affiliation: Diego de Alcalá Martínez Gómez, Hospital Universitario J.M. Morales Meseguer, Avda. Marqués de los Vélez sn. Murcia, Spain. diegoa.martinez@carm.es.
authors.forename: D A
authors.initials: DA
authors.lastname: Martínez-Gómez
authors.forename: M A
authors.initials: MA
authors.lastname: Moreno-Carrillo
authors.forename: A
authors.initials: A
authors.lastname: Campillo-Soto
authors.forename: A
authors.initials: A
authors.lastname: Carrillo-García
authors.forename: J L
authors.initials: JL
authors.lastname: Aguayo-Albasini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D019091:Critical Pathways; D048909:Diabetes Complications / Q000453:epidemiology* / Q000451:nursing / Q000601:surgery*; D017719:Diabetic Foot / Q000601:surgery; D003927:Diet, Diabetic; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010348:Patient Care Team; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology