Oral Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

Diabetes-related major amputations: a ten-year audit of patient characteristics and mortality outcomes (128506)

Francesca D'Elia 1 , Huy Do 1 , Casie Barrette 2 , Fiona Bodey 1 , Bernard Allard 3 , Shane Hamblin 1 4 , Hanh Nguyen 1 4
  1. Department of Endocrinology, Western Health, Melbourne, Victoria, Australia
  2. Department of Podiatry, Western Health, Melbourne, Victoria, Australia
  3. Department of Vascular Surgery, Western Health, Melbourne, Victoria, Australia
  4. Department of Medicine, Melbourne University, Melbourne, Victoria , Australia

Background: Major amputation(MA) secondary to diabetes-related foot disease (DFD) is a significant health burden. To our knowledge, there is minimal research on the determinants of MA and subsequent outcomes in a modern Australian population.

Aim:To describe the burden, determinants and outcomes of MA associated with DFD at a tertiary Victorian hospital between 2013-2022.

Methods: Inpatients aged >18 years with diabetes mellitus and a MA (occurring at/above the ankle joint) were identified by ICD-10AM codes. Demographic, mortality (recorded until June 2025) and comorbidity data were extracted from the hospital electronic database. Ethnicity was determined by birth country and coded according to the ABS classifications(1). Socioeconomic status (SES) was coded by postcode and grouped according to ABS IRSAD scores(2).

Results: At Western Health, 133 individuals underwent a MA between 2013-2022. Majority were male (77.4%) with a mean age of 65±11.8 years. Overseas-born cases comprised 43.6% of the cohort, primarily from South-Eastern Europe (18.0%), followed by North-Western Europe (11.3%). Only one patient identified as First Nations, with no mortality in this group. Majority had a diagnosis of T2DM (90.2%), with a mean HbA1c and LDL of 8.3±1.9%, 1.6±0.7mmol/L, respectively. SES was denoted by a mean IRSAD score of 2.7±1.3 (mode 3).  Neuropathy, PVD and prior minor amputation were recorded in 68.4%, 73.7% and 39.1%, respectively. Wound chronicity of ulcers demonstrated 31.5% present for <1 month and 25.6% present for >6 months. A significant mortality burden was identified, with a mean Charlson Comorbidity Index of 7.2±2.9, all-cause mortality of 51.1% and a 2-year mortality of 31.5%. Median time-to-death was 483.5 days (IQR 1110). The most common causes of death were sepsis (17.6%), cardiac arrest (17.6%) and end-stage renal disease (10.2%).

Conclusion: Individuals with DFD-associated MAs have significant all-cause mortality risk. Further research to understand the determinants of MA and mortality is currently underway.

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  1. (1) Australian Bureau of Statistics Standard Australian Classification of Countries (SACCC) - https://www.abs.gov.au/statistics/classifications/standard-australian-classification-countries-sacc/latest-release
  2. (2) Australian Bureau of Statistics Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2021- Socio-Economic Indexes for Areas (SEIFA), Australia 2021