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Open Access Research

What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

Peter A Lazzarini123*, Sharon R O’Rourke4, Anthony W Russell56, Damien Clark23 and Suzanne S Kuys17

Author Affiliations

1 Allied Health Research Collaborative, Metro North Health Service District & Queensland University of Technology, The Prince Charles Hospital, Rode Road, Chermside QLD, 4032 Brisbane, Australia

2 Department of Podiatry, Metro North Health Service District, Queensland Health, Brisbane, Australia

3 School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia

4 Cairns Diabetes Centre, Cairns and Hinterland Health Service District, Queensland Health, Cairns, Australia

5 Department of Diabetes & Endocrinology, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia

6 School of Medicine, University of Queensland, Brisbane, Australia

7 Musculoskeletal Research Program, Griffith Health Institute, Griffith University, Gold Coast, Australia

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Journal of Foot and Ankle Research 2012, 5:12  doi:10.1186/1757-1146-5-12

Published: 30 May 2012

Abstract

Background

Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations.

Methods

Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197). All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p < 0.05 was used throughout.

Results

One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%), peripheral arterial disease (non-diabetes) (18%), trauma (8%), type 1 diabetes (7%) and malignant tumours (5%). Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p < 0.01). Reliability of original hospital coding was high with Kappa values over 0.8 for all variables.

Conclusions

This study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have diabetes. It is recommended that large prospective studies are implemented and national lower extremity amputation rates are established to address the large preventable burden of lower extremity amputation in Australia.

Keywords:
Amputation; Foot; Diabetes; Peripheral arterial disease; Trauma