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

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.