Diabetes‐Related Foot Disease as the Principal Reason for Hospital Admission: 5 Years of Data From a Major Tertiary Hospital in Aotearoa New Zealand

Abstract

ABSTRACT Objective To examine hospitalisations caused by diabetes‐related foot disease (DFD) at the largest tertiary hospital in Aotearoa New Zealand. Methods We analysed hospital admission data for DFD‐caused hospitalisations from Auckland City Hospital (ACH), from 1 July 2014 to 30 June 2019, for people 15 years or older, using ICD10‐AM discharge codes and amputation procedure codes. DFD‐caused hospitalisations were defined where DFD was the principal reason for admission. Demographic variables and length of stay were also collected. Results During the study period, out of the total 11,222 hospitalisations in persons with diabetes, 1605 (14.3%) were DFD‐caused hospitalisations, which included 265 (16.5%) minor amputations and 94 (5.9%) major amputations. There were a total of 71,033 hospital bed days in persons with diabetes, of which 16,992 (23.9%) hospital bed days were due to DFD. Median length of stay in days was 4 (IQR: 1–8) for persons with diabetes; 7 (3–14) for DFD‐caused hospitalisations, 13 (8–22) for minors and 17 (13–26) for major amputations. The DFD‐caused hospitalisation rate per 1000 persons with diabetes increased by 86% from 6.2 (95% CI: 5.2, 7.2) in 2014/15 to 11.5 (10.2, 12.8) in 2018/19 and combined minor and major amputation rates increased 82% from 1.1 (0.7, 1.5) to 2.0 (1.4, 2.5). The rate of first DFD‐caused hospitalisation was highest for Māori at 7.5 (5.8 9.5), followed by Pacific at 5.3 (4.5, 6.2) and lowest for European/Other at 3.7 (3.3, 4.1) per 1000 person‐years with diabetes. Conclusion DFD‐caused hospitalisations and amputations made up nearly a quarter of all hospital bed days used by people with diabetes and nearly doubled over 5 years. The highest rates were found in adults of Māori and Pacific ethnicity. Most DFD‐caused hospitalisations did not involve amputations (78%). The high and increasing burden of DFD‐caused hospitalisations suggest surveillance could monitor necessary changes to preventative foot care services.