Citation: International Journal of Surgery. 2013, 11(8), 734-735
Author: Barkat M.; Appleton N.; Chatha R.; Chan C.
Abstract: Aim: In-hospital mortality rates for patients undergoing diabetic foot surgery range from 9% (National Vascular Database) to 17% (Hospital Episode Statistics data). This compares unfavourably with 4% for that of open AAA surgery. Our aim was to evaluate outcomes following major diabetic foot amputations in a district general hospital. Method: A retrospective case note review of consecutive patients undergoing major amputation for diabetic foot complications over a three year period. Results: Between
August 2009 to August 2011, 75 patients underwent major amputations: (50% trans-femoral, 42% trans-tibial and 8% other). Indications included ischaemia (41%), sepsis (40%) or both (19%). 36% developed medical complications postoperatively: (25% chest infection, 8% cardiac failure and 3% urosepsis). Mean post-operative length of stay was 35 days (range 1 - 215). In-hospital mortality rate was 16.3% and at one year was 26.6%. Conclusion: The post-operative management of diabetic patients requiring major amputation is associated with a high medical complication rate. We have shown that worryingly, in-hospital mortality for this group is higher than that for open AAA surgery. Prioritisation at all levels of hospital care is required to deliver improved outcomes.
