CURRENT TREND OF DIABETIC FOOT SURGERY IN GENERAL HOSPITAL OF KSA: ARE WE DOING ENOUGH TO AVOID AMPUTATIONS? Dr. Anthony Morgan, Dr. Adel Mohammad bin Sultan, Dr. Abdullah Mussad Al Harbi. College of Medicine, Prince Sattam Bin Abdulaziz University Al kharj, Saudi Arabia

PRINCE SATTAM BIN ABDULAZIZ UNIVERSITY KING KHALID HOSPITAL IN AL KHARJ

INTRODUCTION Diabetes Mellitus is a leading health problem in middle east and Saudi Arabia. About 3.4 million cases of DM in KSA registered in 2015. About 48% of adult population above age of 40 suffering from DM and it’s complications. Big impact on socio-economic development. Large burden for KSA health system in general. This study was aiming to evaluate a pattern of diabetic foot presentations. Current investigation and treatment in Al Kharj area population.

INTERNATIONAL DIABETES FEDERATION

DM COMPLICATIONS Retinopathy. Nephropathy. Diabetic induced atherosclerotic changes in arterial tree. Micro-angiopathy and neuropathy leading to diabetic foot development. Fast development of necrotising processes in poor controlled cases. Diabetic foot associated with virulent infection, which leads to amputations. High morbidity and mortality. WHO data up to 70% of non-traumatic amputations of the lower extremity are made for patients with Diabetes Mellitus.

MATERIALS AND METHODS Retrospective study based on data from the Department of Surgery at King Khaled Hospital. Teaching hospital for public admissions in Al Kharj Governate of Saudi Arabia with population over 650,000 people. 81 patients admitted from 2010 to 2015 with diabetic foot wounds. Inclusion criteria in this study: infected ulcers to necrotising wounds and gangrene at level of toes, mid foot and below knee. Patients who ended up with amputation were analysed for risk factors. Multiple factors: age, gender, DM duration, level of education, diabetic control, BMI, smoking collected in data and analyzed.

Typical presentations for acute and recurrent ulcerations and infections

High rate of infected wound debridement and toe amputations

RESULTS: AGE

RESULTS: COMORBIDITIS

RESULTS: EDUCATION

RESULTS: VASCULAR STUDIES From all 81 patients social history of cigarette smoking was accounted in 51 (63%). 65 patients (80.2%) had a vascular Doppler study. Peripheral arteries at different levels on the side of affected leg were occluded in 35 (43.2%) patients.

RESULTS: DOPPLER STUDY

RESULTS: SURGICAL TREATMENT Surgical Interventions   MALE % FEMALE DEBRIDEMENT 30 61.2% 18 56.3% AMPUTATION 19 38.8% 14 43.8% TOTAL 49 100.0% 32

RESULTS: AMPUTATIONS

RESULTS: HOSPITAL STAY The mean duration of hospital stay was 21.44 +/-17.7 days. Cost of surgical bed for one day in KSA = 600 SAR HOSPITAL STAY Days MALE PERCENTAGE FEMALE < 5 26 53.1% 15 46.9% <10 10 20.4% 9 28.1% <20 5 15.6% <30 3 6.1% 9.4% TOTAL 49 100.0% 32

CONCLUSIONS Delayed presentation of the patients with complicated diabetic foot is the reason for high amputation rate. Diabetic foot complications remain common reason for hospital admissions and have high impact on the cost of hospital care in Saudi Arabia. Lack of diabetic foot educational and screen programs in Al Kharj city are major contributing factors leading to diabetic foot complication and amputations. Development of specialised diabetic centres is needed to use multidisciplinary approach to minimise morbidity and mortality in this group of patients.

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