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Prevention of Major Amputation secondary to Diabetes-related Foot Disease / JENNIFER HAYES

Swansea University Author: JENNIFER HAYES

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DOI (Published version): 10.23889/SUthesis.60123

Abstract

Incidence of amputation secondary to diabetic foot disease is unacceptably high, especially as up to 80% of these amputations are deemed preventable through optimal management and education. Tackling complications and reducing amputation rates requires a holistic approach identifying issues at a per...

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Published: Swansea 2022
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Stephens, Jeffery W. ; Wilkinson, Laura I.
URI: https://cronfa.swan.ac.uk/Record/cronfa60123
first_indexed 2022-06-01T15:50:49Z
last_indexed 2022-06-02T03:33:01Z
id cronfa60123
recordtype RisThesis
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spelling 2022-06-01T17:05:44.5963860 v2 60123 2022-06-01 Prevention of Major Amputation secondary to Diabetes-related Foot Disease 46ad14be4a790b5caa6b880fb5908dca JENNIFER HAYES JENNIFER HAYES true false 2022-06-01 Incidence of amputation secondary to diabetic foot disease is unacceptably high, especially as up to 80% of these amputations are deemed preventable through optimal management and education. Tackling complications and reducing amputation rates requires a holistic approach identifying issues at a person, system and population level. Investing in preventive strategies is cost effective and avoids the burden of extremely costly reactive interventions. The overarching aim of this thesis was to understand the previously undocumented burden of diabetes-related amputation and the associated risk factors for amputation within Wales. The thesis investigated amputation rates and mortality in the Welsh population with and without diabetes over the last decade for both major and minor amputations using a repository of medical data of all Welsh residents. The thesis also examined risk factors for amputation at a person, health board and population level using different methodologies to quantify specific risks. This included root cause analysis to assess care provision and questionnaires to understand patient’s knowledge and behaviours. The thesis identified variance from gold standards of care for diabetic foot disease and most amputations in the root cause analysis were determined potentially preventable. However, it identified simple behavioural and educational measures and areas for implementation of risk reduction strategies within our health board. Despite the population with diabetes representing only 7% of the total Welsh population, they accounted for over 50% of the incident amputations performed. Only a minor reduction in rate of amputation was seen over time and there was marked variance in rates between health boards. Mortality following major amputation was high with a mortality rate of 61.9% at 5 years in the total population and 67% in the population with diabetes. By highlighting variance and current trends in care the thesis provides the grounds for the implementation of interventions to reduce amputation rates. E-Thesis Swansea Medicine, Diabetes, Amputation, Peripheral vascular disease 1 6 2022 2022-06-01 10.23889/SUthesis.60123 COLLEGE NANME COLLEGE CODE Swansea University Stephens, Jeffery W. ; Wilkinson, Laura I. Doctoral Ph.D 2022-06-01T17:05:44.5963860 2022-06-01T16:47:51.7296247 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine JENNIFER HAYES 1 60123__24225__6592ffff55ba45bba860cb313cee5c40.pdf Hayes_Jennifer_PhD_Thesis_Final_Redacted_Signature.pdf 2022-06-01T17:04:01.1067511 Output 12683850 application/pdf E-Thesis – open access true Copyright: The author, Jennifer Hayes, 2022. true eng
title Prevention of Major Amputation secondary to Diabetes-related Foot Disease
spellingShingle Prevention of Major Amputation secondary to Diabetes-related Foot Disease
JENNIFER HAYES
title_short Prevention of Major Amputation secondary to Diabetes-related Foot Disease
title_full Prevention of Major Amputation secondary to Diabetes-related Foot Disease
title_fullStr Prevention of Major Amputation secondary to Diabetes-related Foot Disease
title_full_unstemmed Prevention of Major Amputation secondary to Diabetes-related Foot Disease
title_sort Prevention of Major Amputation secondary to Diabetes-related Foot Disease
author_id_str_mv 46ad14be4a790b5caa6b880fb5908dca
author_id_fullname_str_mv 46ad14be4a790b5caa6b880fb5908dca_***_JENNIFER HAYES
author JENNIFER HAYES
author2 JENNIFER HAYES
format E-Thesis
publishDate 2022
institution Swansea University
doi_str_mv 10.23889/SUthesis.60123
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Incidence of amputation secondary to diabetic foot disease is unacceptably high, especially as up to 80% of these amputations are deemed preventable through optimal management and education. Tackling complications and reducing amputation rates requires a holistic approach identifying issues at a person, system and population level. Investing in preventive strategies is cost effective and avoids the burden of extremely costly reactive interventions. The overarching aim of this thesis was to understand the previously undocumented burden of diabetes-related amputation and the associated risk factors for amputation within Wales. The thesis investigated amputation rates and mortality in the Welsh population with and without diabetes over the last decade for both major and minor amputations using a repository of medical data of all Welsh residents. The thesis also examined risk factors for amputation at a person, health board and population level using different methodologies to quantify specific risks. This included root cause analysis to assess care provision and questionnaires to understand patient’s knowledge and behaviours. The thesis identified variance from gold standards of care for diabetic foot disease and most amputations in the root cause analysis were determined potentially preventable. However, it identified simple behavioural and educational measures and areas for implementation of risk reduction strategies within our health board. Despite the population with diabetes representing only 7% of the total Welsh population, they accounted for over 50% of the incident amputations performed. Only a minor reduction in rate of amputation was seen over time and there was marked variance in rates between health boards. Mortality following major amputation was high with a mortality rate of 61.9% at 5 years in the total population and 67% in the population with diabetes. By highlighting variance and current trends in care the thesis provides the grounds for the implementation of interventions to reduce amputation rates.
published_date 2022-06-01T05:06:48Z
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score 11.098395

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