A Retrospective Study on Related factors for Diabetic Lower Extremity Amputations at CWM Hospital from 2016 to 2017

Researchers: Timoci Q PN1, McCaig E4, Batikawai A3
Researcher Affiliations:
Department of Surgery, CWM Hospital, Fiji/Fiji National University (FNU)
Key Words: Lower Extremity Amputation (LEA), Below Knee Amputations (BKA), Complicated Diabetic Foot Infections, Diabetic Related Amputations, Developing countries, high risk foot.
Introduction: Developing countries such as in the Pacific (Fiji) tend to assume that our Diabetic patients do present late with Complcated Diabetic Foot Infections or “high risk foot” that has led to the high rates of Diabetic related Amputations.The International Diabetic Federation(IDF) has rated Fiji as having the Worst Life Expectancy raking on Diabetes (187.9/per 100,000).With an adult population of 562,700 there is an approxmation of 81,700 Diabetics. This number is still an under estimation to the statistical burden of disease in this country.For a small country population of 912,241; CWM Hospital caters for more tha 330,000 people and had a total of 475 Diabetic Related Amputations in 2017 alone with BKA’s leading the figures at 166.
Objectives:
1. To profile the Fijian Diabetic Amputee.
2. Identify that most of our Diabetics “present late” with Complicated Diabetic Infections.
3. Describe other related factors for Diabetic related Lower Extremity Amputations at CWM Hospital.
Method(s): a retrospective study at CWM Hospital on all Diabetic related below knee amputations from January 2016 to January 2017. Information were collected from PARU register and correlated with the computerised Patient Information System (PATIS).Relevant demorgraphic, clinical and laboratory details were obtained and entered on EXCEL spreadsheets for data analysis.
Results: of the 112 BKA’s done, the indigenous population accumulated for 71% of all amputations.the age group peaked between the 50- 64 years with male predominancy.69% of amputees lived within the city suburbs.75% had uncotrolled RBS on arrival to ED.93% needed an amputation within 5 days of admission and 56% had an amputation within 24 hours of admission.Almost 30% had become a bilateral amputee on completion of BKA admission.90% of the BKA’s had presented with a Wagner Grade 3 and 4 signifying the “late presentations” of these patients. Lab findings concluded that 90% were anaemic;70% had Egfr of less than 89mil/mim (CKD grade 2).
Conclusion:
Able to profile the probable Fijian Diabetic Amputee as the above 50 year old Indigenous I- Taukei male who resides within the city suburds,has multiple comorbitidies,anaemic, who presents late with at least a Wagner 3 complicated gangrenous foot infection and uncontrolled high RBS.We were able to prove that the patients in this setting do “present late” with complicated gangrenous foot infections neccessitating life saving BKA amputation.