Most lower limb amputations in Canada due to diabetes: a study

Article content

Diabetes accounts for about two-thirds of lower limb amputations in Canada, according to a report released this week by the Canadian Institute for Health Information.

CIHI drew on national data from 2020-2023 to develop conclusions and recommendations for diabetes care, focusing on lower limb amputations such as the leg, foot or toes.

Diabetes-related lower limb amputations are largely preventable and have high health system and societal costs, says CIHI.

Article content

However, its report notes that in each year studied, there were about 7,720 hospitalizations for diabetes-related lower limb amputations., of which 3,080 are leg amputations. There were also 23,500 diabetes-related admissions to treat ulcers, gangrene or infections.

Big price tag for health care for amputees with diabetes

CIHI estimates that these hospitalizations account for approximately $750 million in health care costs annually. “However,” the report says, “this reflects a fraction of the total system costs associated with diabetic foot ulcers and amputations.”

The data collected shows that patients who had a leg amputated spent about 19 days in hospital. They often require multiple operations and are at high risk of readmission, as well as ‘death in hospital’. The cost of these hospitalizations comes with a hefty price tag, according to the report: about $47,000 per stay.

At the same time, people hospitalized for a wound or amputation regularly have repeat hospitalizations related to lower extremity complications. Of the 31,220 hospitalizations annually for diabetes-related lower extremity complications, about 19,100 were for individual patients. The remaining 12,120 were repeat visits during the year.

Article content

Article content

The analysis shows that 19 percent of patients who had a leg amputation were readmitted for a second amputation or for treatment of ulcers, gangrene and infection (UGI) within 12 months.

And up to eight percent of patients died in hospital within 30 days of being hospitalized for a leg amputation. This is more than four times the rate of 30-day in-hospital mortality after major surgery. The 30-day in-hospital mortality rates for ankle, foot, or toe amputations and for UGI admissions are 3 percent and 8 percent, respectively.

Disparities in amputation rates across Canada

The study looked for disparities among sufferers and their treatment across the country. Among the main results:

• About 43 percent of the amputations occurred among those aged 40 to 64.
• Men with diabetes were two to three times more likely than women to have an amputation or be hospitalized for lower extremity complications.
• Lower extremity complications were also more common in those living in neighborhoods with lower income, lower secondary school attendance and greater social deprivation, as well as in rural and remote communities.

Article content

As neighborhood income increased, amputation rates decreased for both men and women. Men living in the lowest income neighborhoods had very high amputation rates. 24 out of every 100,000, the age-standardized rate of amputation in men living in the lowest-income neighborhoods is 8 times higher than in women in the highest-income neighborhoods (three out of every 100,000).

The incidence of amputation ranged from seven per 100,000 in accessible large urban centers to 49 per 100,000 in very remote communities. Across Canada, more than three-quarters (77 percent) of the total population live in easily accessible urban areas, and about two percent live in either remote or very remote areas.

The study used the Distance Index, which includes a travel budget. Fewer health workers working in rural and remote communities contribute to higher travel costs and longer waiting times to access services.

For diabetic foot care, CIHI says, providers who provide critical preventive services, such as podiatrists, podiatrists, podiatrists, and vascular surgeons, are concentrated in large urban centers.

Article content

Move to focus on diabetes prevention

Preventing complications of diabetes such as amputations must start by reducing the risk of developing type 2 diabetes and ensuring that all types of diabetes are diagnosed promptly, says CIHI.

Primary care is important for people to have regular access to diabetes prevention interventions, including smoking cessation programs, cardiovascular risk reduction, exercise, weight loss and healthy behavior interventions. Most type 2 diabetes screenings are also done in primary care. Screening is recommended every three years from age 40, or earlier if the patient is at high risk, the report says.

About 3.7 million people (9.4 percent) had been diagnosed with diabetes in Canada as of 2020–2021, and at least 2 percent of adults have undiagnosed diabetes, according to Public Health Canada. The total number of people living with diabetes is increasing over time due to an aging population and increasing incidence.

For those living with diabetes, the lifetime risk of developing a foot ulcer is about 15 percent to 25 percent, CIHI says. That means “about 550,000 to 920,000 Canadians currently living with diabetes are predicted to develop some form of foot complication, putting them in need of specialized services and at greater risk of lower limb amputation if their care needs are not met.”

Article content

Patients with lower limb amputations may experience reduced function, reduced quality of life, depression, and a high risk of premature death. However, says CIHI, it is widely cited that up to 85 percent of amputations are preventable.

CIHI is encouraging health authorities across the country to use their findings to prevent amputations and other complications of diabetes. “Health systems can use this information to support strategies that improve access to health care and early intervention for patients at higher risk of diabetes complications.”

Our website is the place for the latest news, exclusive scoops, long reads and provocative commentary. Please bookmark nationalpost.com and sign up for our newsletters here.

Article content