Diabetes and lower extremity amputation – rehabilitation pathways and outcomes at a regional hospital

Keywords: prevalence, diabetes mellitus, lower extremity amputations, rehabilitation, physiotherapy

Abstract

Background: Lower extremity amputations (LEAs) are most frequently due to diabetes mellitus (DM), a disease on the rise. The objective of this study was to determine the prevalence and aetiology of LEAs at Addington Hospital from 2013 to 2017 and to explore the physiotherapy referral practices and outcomes.

Methods: Retrospective study carried out at Addington Hospital, Durban. Patients who underwent LEAs were filtered from theatre registers and the hospital Meditech database. Data collected included patients' demographic profile, diabetic status, level of amputation, limb orientation, physiotherapy referral status, and rehabilitation outcomes. Physiotherapy files were scanned for the attendance of referred patients. Study endpoints were prevalence, diabetes status, referral status, compliance and rehabilitation outcomes.

Results: From 2013 to 2017, 1 028 LEAs in 843 patients were identified with single amputations (697) and multiple amputations (146). The median age was 61 (IQR 52–68) years, and the M:F ratio was 1.3:1. A total of 574 (68.1%) patients had DM. Seven hundred and thirty-eight (71.8%) amputations were as a result of DM. The level of amputations was below-knee (479; 46.6%), toectomy (236; 23%), above-knee (196; 19%) and trans-metatarsal (117; 11.4%). Only 148 patients (17.6%) were referred for physiotherapy, of which 91 (61.5%) attended. Mobility in those who attended rehabilitation was with a walking frame (51; 56%), crutches (29; 31.9%), prosthesis and  crutches (7; 7.7%), and wheelchair-bound (4; 4.4%).

Conclusion: Over half the amputations were associated with DM, which was also a risk factor for multiple amputations. Although referral and attendance for physiotherapy were very poor, mobility in those who attended was excellent, indicating a dire need to improve hospital referral pathways.

Author Biographies

P Manickum, University of KwaZulu-Natal

School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa

S S Ramklass, University of KwaZulu-Natal

School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa

T E Madiba, University of KwaZulu-Natal

Department of General Surgery, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa

Published
2021-09-10
How to Cite
Manickum, P., Ramklass, S., & Madiba, T. (2021). Diabetes and lower extremity amputation – rehabilitation pathways and outcomes at a regional hospital. South African Journal of Surgery, 59(3), 128. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3264
Section
General Surgery