The diabetic foot in Dutch hospitals: epidemiological features and clinical outcome

To assess the impact of the diabetic foot on the hospitalization of patients with diabetes mellitus in The Netherlands.

Data on hospitalizations of patients with diabetes mellitus for the years 1988 and 1989 were obtained from the Dutch Information System on Hospital Care. Analysis of the data was performed if in the discharge summary a code number for chronic ulcer of the lower extremity, osteomyelitis or gangrene was reported.

In 1988 20.4% of all hospitalized diabetics were reported to have foot problems. The men age of the study population was 71.3 +/- 12.1 years for 1988 and 71.2 +/- 11.9 for 1989. In patients who underwent (partial) limb amputation the M/F ratio was higher than in patients without amputation for all patient groups studied (p < 0.001). In 1988, 3707 and in 1989, 3790 patients were hospitalized for diabetic foot problems. The cumulative costs were calculated to be 38,556,960 ECU for 1988 and 37,720,020 ECU for 1989. The mean duration of hospitalization was 40.0 days in 1988 and 38.3 days in 1989. Patients with limb amputation stayed significantly longer in the hospital than patients without amputation (p < 0.001). Overall in-hospital mortality was 10%. Mortality was highest in patients staged Wagner 4 + 5. Mortality among patients staged Wagner 1 and 2 was higher than in patients with osteomyelitis (p < 0.001). Of all patients, approximately 10% were discharged to a rehabilitation centre or nursing home.

Both the mean age of the patients hospitalized and the total amount of costs involved are higher than put forward previously in studies from the US Diabetic foot problems put a heavy burden on the health status of elderly diabetic patients. Financial resources should be reallocated in the direction of preventive health care.