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Reduction in Diabetic Amputations Over 11 Years in a Defined U.K. Population

Benefits of multidisciplinary team work and continuous prospective audit

Ipswich Diabetic Foot Unit, Ipswich Hospital, Suffolk, U.K

Address correspondence and reprint requests to Gerry Rayman, MD, Ipswich Hospital, Diabetes Center, Heath Road, Ipswich, Suffolk IP4 5PD, U.K. E-mail: gerry.rayman{at}ipswichhospital.nhs.uk

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.

RESEARCH DESIGN AND 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.

Abbreviations: LEA, lower-extremity amputation

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