Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Observational study of admissions to the inpatient Multidisciplinary Diabetic Foot Unit at Fiona Stanley Hospital: Patient outcomes at 12 months (#286)

Emma J Hamilton 1 2 , Wendy A Davis 3 , Lydia Lamb 1 , Dipen Sankhesara 4 , Tina Dilevska 5 , Erica Ryan 6 , Mendel Baba 6 , Jonathan Hiew 6 , Ashley Makepeace 1 , P. Gerry Fegan 1 , Carsten Ritter 5 , Laurens Manning 7
  1. Endocrinology Department, Fiona Stanley Hospital, Perth, WA, Australia
  2. Fiona Stanley Hospital, Murdoch, WA, Australia
  3. Medical School, University of Western Australia, Fremantle Hospital, Perth, WA, Australia
  4. General Medicine, Fiona Stanley Hospital, Perth, WA, Australia
  5. Vascular Surgery Department, Fiona Stanley Hospital, Perth, WA, Australia
  6. Podiatry Department, Fiona Stanley Hospital, Perth, WA, Australia
  7. Infectious Diseases Department, Fiona Stanley Hospital, Perth, WA, Australia

Background

Foot ulceration is the leading cause of hospitalisation for people with diabetes and diabetes is the most common cause of non-traumatic lower limb amputation.  A multidisciplinary approach to diabetic foot disease reduces amputation rates and improves wound healing.  In February 2015, the first inpatient Multidisciplinary Diabetic Foot Unit (MDFU) in Western Australia was opened at Fiona Stanley Hospital (FSH).

Aims

To describe baseline characteristics and 12 month outcomes of patients admitted to the FSH MDFU in the first year of operation.

Methods

A retrospective observational study was conducted of 151 admissions in 128 patients admitted to the FSH MDFU from 1st February 2015 to January 31st 2016. Patient outcomes were described 12 months after index admission.

Results

The 128 patients had a mean age of 60.4±14.9 years, 69.5% were male, 11.7% were Indigenous Australians and 23.0% lived outside the Perth metropolitan area.  85.9% had type 2 diabetes, 11.7% type 1 diabetes and 2.3% no diabetes.  Median length of stay was 9 days.  12 months after the index admission, in 37.8% the wound had healed but in 14.8% it persisted, whilst 8.6% had died, 8.6% had undergone a major amputation, and 7.0% required further debridement/minor amputation.  In the 48 whose wound healed, it took on average 151 (range 34-363) days to heal. Three-quarters of these wounds were located at the forefoot. Those who died had significantly worse renal function (lower estimated glomerular filtration rate) than those who had further debridement/minor amputation, or whose index wound healed, or were lost to follow-up (Bonferroni-adjusted p<0.05).    

Conclusions

12 months after index admission to the MDFU, major amputation rates were low (8.6%) and 37.8% achieved wound healing.  Patients who were deceased at 12 months follow-up had significantly worse renal function suggesting chronic kidney disease may predict poorer health outcomes in this cohort.