ICD codes (ICD-10-AM) used to identify a principal diagnosis of a diabetes foot-related complication.

ICD codes (ICD-10-AM) used to identify a principal diagnosis of a diabetes foot-related complication.

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To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia) between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management. All data from cases admitted for the principal reason of diabetes foot-related hospitali...

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... Each year DFD affects approximately 50,000 Australians, with a further 300,000 having risk factors for developing DFD [1][2][3][4]. Although DFD causes a large disease burden, Australian regions that have systematically introduced multi-disciplinary foot care services which adhered to evidence-based DFD guideline recommendations, have significantly reduced their burden of DFD [7][8][9]. ...
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Background Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD. Methods We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting guidelines. We systematically searched for all international DFD guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6–8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel’s and international guideline’s judgements. Each panel drafted a guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies. Results We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ Conclusion New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia.
... Participants were considered censored if: 1. they had a lower-extremity amputation before being ulcer-free, including minor amputation (defined as an amputation procedure below the ankle level) and major amputation (amputation above the ankle level); 2. they died before being ulcer-free; 3. they ceased visiting the service before being ulcer-free and were lost to follow-up; or 4. their ulcer(s) had not healed by the end of the 24 month period. The information on amputation was identified via standard ICD-10-AM amputation procedure codes (provided in Table 1) from linked Queensland Hospital Admitted Patient Data Collection, which captures all hospitalisation procedures in public and private hospitals in Queensland [32]. Time-to-ulcer-free was defined as the time in days between the date of the participant's first visit and the date of the first visit in which all DFUs healed (was ulcer-free), while for censored participants time-tocensoring was defined as between the date of first visit and the date censored. ...
Article
Aims: To investigate factors independently associated with time-to-(being)-ulcer-free, time-varying effects and predict adjusted ulcer-free probabilities, in a large prospective cohort with diabetes-related foot ulcers (DFU) followed-up for 24 months. Methods: Patients presenting with DFU(s) to 65 Diabetic Foot Services across Queensland, Australia, between July-2011 and December-2017 were included. Demographic, comorbidity, limb, ulcer, and treatment factors were captured at presentation. Patients were followed-up until ulcer-free (all DFU(s) healed), amputation, death or two years. Factors associated with time-to-ulcer-free were investigated using both Cox proportional hazards and flexible parametric survival models to explore time-varying effects and plot predicted adjusted ulcer-free probability graphs. Results: Of 4,709 included patients (median age 63 years, 69.5% male), median time-to-ulcer-free was 112 days (IQR:40->730), with 68.4% ulcer-free within two years. Factors independently associated with longer time-to-ulcer-free were each year of age younger than 60 years, living in a regional or remote area, smoking, neuropathy, peripheral artery disease (PAD), ulcer size >1cm2, deep ulcer and mild infection (all p<0.05). Time-varying effects were found for PAD and ulcer size limiting their association to six months only. Shorter time-to-ulcer-free was associated with recent DFU treatment by a podiatrist and receiving knee-high offloading treatment (both p<0.05). Predicted adjusted ulcer-free probability graphs reported largest differences in time-to-ulcer-free over 24-months for geographical remoteness and PAD factors. Conclusions: Multiple factors predicted longer and shorter time-to-ulcer-free in people presenting with DFUs. Considering these factors, their time-varying effects and adjusted ulcer-free probability graphs, should aid the prediction of the likely time-to-(being)-ulcer-free for DFU patients.
... LEAs were defined as an admission with any procedure code for a major amputation (through or above the ankle; procedure codes: 4436700, 4436701, 4436702, 4437000, 4437300) or minor amputation (below the ankle; procedure codes: 4433800, 4435800, 4436100, 4436101, 4436400, 4436401, 9055700). We also stratified by major and minor amputations, using the highest level amputation for the admission when more than one amputation procedure code was present (20,21). ...
Article
OBJECTIVE To determine trends in the incidence of major diabetes-related complications in Australia. RESEARCH DESIGN AND METHODS This study included 70,885 people with type 1 and 1,089,270 people with type 2 diabetes registered on the Australian diabetes registry followed from July 2010 to June 2019. Outcomes (hospitalization for myocardial infarction [MI], stroke, heart failure [HF], lower-extremity amputation [LEA], hypoglycemia, and hyperglycemia) were obtained via linkage to hospital admissions databases. Trends over time in the age-adjusted incidence of hospitalizations were analyzed using joinpoint regression and summarized as annual percent changes (APCs). RESULTS In type 1 diabetes, the incidence of all complications remained stable, except for stroke, which increased from 2010–2011 to 2018–2019 (financial years; APC: +2.5% [95% CI 0.1, 4.8]), and hyperglycemia, which increased from 2010–2011 to 2016–2017 (APC: +2.7% [1.0, 4.5]). In type 2 diabetes, the incidence of stroke remained stable, while the incidence of MI decreased from 2012–2013 to 2018–2019 (APC: −1.7% [95% CI −2.8, −0.5]), as did the incidence of HF and hypoglycemia from 2010–2011 to 2018–2019 (APCs: −0.8% [−1.5, 0.0] and −5.3% [−6.7, −3.9], respectively); the incidence of LEA and hyperglycemia increased (APCs: +3.1% [1.9, 4.4], and +7.4% [5.9, 9.0]). Most trends were consistent by sex, but differed by age; in type 2 diabetes most improvements were confined to individuals aged ≥60 years. CONCLUSIONS Trends in admissions for diabetes-related complications were largely stable in type 1 diabetes. In type 2 diabetes, hospitalization rates for MI, HF, and hypoglycemia fell over time, while increasing for LEA and hyperglycemia.
... The study outcome variables were DFD, DFU and DFI, which were dichotomised. DFD included the ulcer of foot or lower limb, decubitus ulcer, peripheral angiopathy with or without gangrene, cellulitis of toe or lower limb, osteomyelitis, mono/polyneuropathy of lower limb, neuropathic arthropathy, and diabetes-related amputation of the lower limb [1,18,19,31]. DFU included ulcer of foot or lower limb, decubitus ulcer, whereas DFI included cellulitis or osteomyelitis of foot or lower limb [1,32,33]. ...
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Background: Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. Methodology: The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient DataCollection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. Results: The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age(75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. Conclusion: Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reportedDFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households.
... Screening agreement between investigators was very high (Cohen's kappa: 0.94). After full-text assessment, 20 publications [10,11,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] were included in this systematic review (see Fig. 1) with 15 excluded for not meeting inclusion criteria (see Table S2). The eligibility criteria for performing any metaanalysis was not met for any outcome of interest and therefore only qualitative analyses of included publications are reported. ...
... Lazzarini,2017 [25] As above As above As above Queensland (Qld), two from Western Australia (WA) and one from Victoria (Vic)) [21,[23][24][25][26][27][28][29]33]; and 40% were region-wide settings (including five from Fremantle (WA) and one each from Far North Qld (Qld), Darwin (Northern Territory (NT)) and Central Australia) [11,18,19,22,30,32,34,35]. ...
... In a state-wide Qld community-dwelling DFD population, previous amputation prevalence was 28.4% [29]. In a state-wide Qld PAD [10,18,21,25,26,29,32,35] Previous foot ulcer [10,25,29,35] Previous amputation [25,29] Foot deformity [27,29] Foot ulcer [18,27,34,35] Foot infection [19,27,29] Total [11,20,21,24,26,28,31,33] Minor [11,19,23,24,28] Major [11,19,[22][23][24]28] Prevalence General population Indicates five recorded a score of 2 (close representation of a national population) and 24 as score of 1 (close representation of a provincial/regional population) inpatient population, diabetes-related previous amputation prevalence was 2.2% (including 9.3% in diabetes inpatients) [25]. ...
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Background Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease), of DFD (ulcers and infection), and of diabetes-related amputation (total, minor and major amputation) in Australian populations. Methods We systematically searched PubMed and EMBASE databases for peer-reviewed articles published until December 31, 2019. We used search strings combining key terms for prevalence or incidence, DFD or amputation, and Australia. Search results were independently screened for eligibility by two investigators. Publications that reported prevalence or incidence of outcomes of interest in geographically defined Australian populations were eligible for inclusion. Included studies were independently assessed for methodological quality and key data were extracted by two investigators. Results Twenty publications met eligibility and were included. There was high heterogeneity for populations investigated and methods used to identify outcomes. We found within diabetes populations, the prevalence of risk factors ranged from 10.0–58.8%, of DFD from 1.2–1.5%, and the incidence of diabetes-related amputation ranged from 5.2–7.2 per 1000 person-years. Additionally, the incidence of DFD-related hospitalisation ranged from 5.2–36.6 per 1000 person-years within diabetes populations. Furthermore, within inpatients with diabetes, we found the prevalence of risk factors ranged from 35.3–43.3%, DFD from 7.0–15.1% and amputation during hospitalisation from 1.4–5.8%. Conclusions Our review suggests a similar risk factor prevalence, low but uncertain DFD prevalence, and high DFD-related hospitalisation and amputation incidence in Australia compared to international populations. These findings may suggest that a low proportion of people with risk factors develop DFD, however, it is also possible that there is an underestimation of DFD prevalence in Australia in the few limited studies, given the high incidence of hospitalisation and amputation because of DFD. Either way, studies of nationally representative populations using valid outcome measures are needed to verify these DFD-related findings and interpretations.
... Diabetes-related foot ulcer (DFU), as a common complication of diabetes, has an annual incidence of approximately 2-8% (Jiang et al., 2015;Lin et al., 2019;Yazdanpanah et al., 2018). Although only about 3% of hospitalized patients with diabetes were hospitalized for their DFUs (Bao et al., 2017;Lazzarini et al., 2015), the 30-day readmission rate of patients with DFUs was as high as 30% (Remington et al., 2016). The two most common reasons for their readmission were infection and uncontrolled hyperglycaemia. ...
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Aims: To explore the factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer. Background: The 30-day readmission rate of patients with diabetes-related foot ulcer can be reduced when good glycaemic control is achieved. The practice of self-monitoring blood glucose promotes optimal glycaemic control. Design: A comparative descriptive study. Methods: In this study, 200 participants, who had been hospitalized due to diabetes-related foot ulcer, were recruited from August 2017 to July 2018. Before participants were discharged from the hospital, psychosocial factors (family support, threat belief, self-efficacy and knowledge) and pre-hospitalization self-monitoring blood glucose behaviour were collected using a structured questionnaire. Then, after discharge, self-monitoring blood glucose behaviour delivery was collected again. Results: Five variables explained 47% of the variance in the delivery of self-monitoring of blood glucose at home. The delivery of hospital-to-home transitional self-monitoring blood glucose behaviour was more likely for individuals with higher pre-discharge self-efficacy, higher post-discharge self-efficacy, more attention to pre-hospitalization glycaemic status and post-discharge insulin usage and those without an insensitive foot. Conclusion: Self-monitoring blood-glucose behaviour should be promoted among post-discharge patients with diabetes-related foot ulcer. The modifiable factors identified in this study can be integrated into the discharge plan.
... Podiatrists have a key role in these multidisciplinary teams as they deal with the prevention, diagnosis and treatment of foot and lower leg conditions, including the management of the diabetic foot [5,6]. Early diagnosis of diabetes-related foot complications such as peripheral arterial disease (PAD) and peripheral neuropathy (PN), along with effective preventative care including appropriate footwear and pressure offloading, reduces risk of diabetic foot ulceration (DFU) and amputation, thereby preserving an individual's mobility and independence and reducing health care costs [5,[7][8][9]. ...
... Podiatrists have a key role in these multidisciplinary teams as they deal with the prevention, diagnosis and treatment of foot and lower leg conditions, including the management of the diabetic foot [5,6]. Early diagnosis of diabetes-related foot complications such as peripheral arterial disease (PAD) and peripheral neuropathy (PN), along with effective preventative care including appropriate footwear and pressure offloading, reduces risk of diabetic foot ulceration (DFU) and amputation, thereby preserving an individual's mobility and independence and reducing health care costs [5,[7][8][9]. ...
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Background People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation. Methods All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted. Results Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% ( n =31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% ( n =12) to 18% n= (13). Conclusion This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented.
... In the second stage, the identification of different types of DFD and DLEA was only ascertained if the foot complications that were found concurrently with or after the diagnosis of diabetes ( Figure 1). In this study, DFD included ulcer of a foot or lower limb, decubitus ulcer, peripheral angiopathy with or without gangrene, cellulitis of a toe or lower limb, osteomyelitis, mono/polyneuropathy of a lower limb, diabetic neuropathic arthropathy, and diabetes-related amputation of a lower limb [39][40][41][42]. DFU included ulcer of foot or lower limb, and decubitus ulcer, whereas DFI included cellulitis and osteomyelitis of toe or lower limb [23,39,43]. ...
... Peripheral angiopathy with gangrene and other gangrene of the lower extremities were classified as DG. Mononeuropathy, polyneuropathy, peripheral angiopathy without gangrene, diabetic neuropathic arthropathy, and other peripheral circulatory complications were included in other DFD [39][40][41][42]. Diagnostic codes of diabetes and related diabetic foot complications are shown in Appendix A Tables A1 and A2. ...
Article
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Diabetes-related foot disease (DFD) is a major public health concern due to the higher risks of hospitalisation. However, estimates of the prevalence of DFD in the general population are not available in Australia. This study aims to estimate the prevalence of DFD and diabetes-related lower-extremity amputation (DLEA) among people aged 45 years and over in New South Wales (NSW), Australia. The NSW 45 and Up Study baseline survey data of 267,086 persons aged 45 years and over, linked with health services’ administrative data from 2006 to 2012 were used in our study. Of these, 28,210 individuals had been diagnosed with diabetes, and our study identified 3035 individuals with DFD. The prevalence of DFD, diabetic foot ulcer (DFU), diabetic foot infection (DFI), diabetic gangrene (DG), and DLEA were 10.8% (95%CI: 10.3, 11.2), 5.4% (95% CI: 5.1, 5.8), 5.2% (95%CI: 4.9, 5.5), 0.4% (95%CI: 0.3, 0.5), and 0.9% (95%CI: 0.7, 1.0), respectively. DFD, DFU, DFI, DG, and DLEA were the most common among those who were older, born in Australia, from low-income households (<AUD 20,000), or were without private health insurance. Interventional messages to reduce all forms of DFD should target those who are from high-risk groups.
... 13 These, among others, have led to a widespread development of multidisciplinary clinics, aiming to implement guidelines and provide secondary and tertiary care for these complex patients. [14][15][16][17] The multidisciplinary treatments have led to an improvement in potential outcomes including better ulcer healing, fewer amputations and a reduced ulcer recurrence. [14][15][16][17] However, during the same period of time, the population of people with diabetes has become more complex, for example because people with diabetes now live longer and the disease develops at a younger age, leading to a higher risk of developing complications. ...
... [14][15][16][17] The multidisciplinary treatments have led to an improvement in potential outcomes including better ulcer healing, fewer amputations and a reduced ulcer recurrence. [14][15][16][17] However, during the same period of time, the population of people with diabetes has become more complex, for example because people with diabetes now live longer and the disease develops at a younger age, leading to a higher risk of developing complications. 14,18 Consequently, the characteristics of the population of people with diabetic foot disease may have changed over the past decades as well. ...
Article
The incidence of diabetes is increasing worldwide with concomitant raising number of patients with diabetic foot disease. Diabetic foot disease treatment has received more attention in the past decades, culminating in the creation of multidisciplinary outpatient clinics, but at the same time, complexity of patients seems to have increased. The aim of this article is to study differences in patient characteristics and outcomes (ulcer healing and ulcer-free survival days) in patients with a diabetic foot ulcer in two prospective cohorts with 15 years in between. Prospective cohort study of all patients in one diabetic foot centre of expertise in 2003–2004 and 2014–2018. Clinical outcomes were determined after a follow-up period of 12 months. Outcomes were differences in baseline characteristics and comorbidities, and differences in ulcer-related outcomes between both cohorts. We included all consecutive diabetic foot ulcer patients from our centre for the period 2003–2004 (n = 79) and 2014–2018 (n = 271). Age (67.0 ± 14.3 vs. 71.6 ± 11.5, p = 0.003) and prevalence of end-stage renal disease (1.3% vs. 7.7%, p = 0.036) were significantly higher in the more recent population. The more recent population had higher healing rate (53.2% vs. 76.4%, p < 0.001), higher median ulcer-free survival days once an ulcer had healed [173 days (IQR 85.3–295.5) vs. 257.0 (IQR 157.0–318.0), p = 0.026], and fewer minor amputations (20.3% vs. 8.1%, p = 0.002). People with diabetic foot ulcers treated in 2014–2018 were older and more frequently diagnosed with ESRD, compared to this population in 2003–2004, while other characteristics were similar; ulcer-related outcomes were better.
... Recent studies have suggested a decline in major amputation rates despite a rise in the prevalence of diabetes [1,3]. A report from Queensland Australia has suggested a significant 45 % decrease in diabetes-related major amputations between 2005 and 2010 [4]. There has been limited study of trends in major amputation rates in high-risk sub-populations, such as Aboriginal and Torres Strait Islander people. ...
... In the final sensitivity analysis the population growth rate was varied between 0.5 and 10 % per annum. The annual incidence of major amputation was estimated as the number of crude amputations in each calendar year (numerator) over the size of the estimated at-risk population for the relevant calendar year (denominator) as previously described [4]. Major amputation incidence rates were stratified by Aboriginal and Torres Strait Islander status and were expressed per 100,000. ...
... Recent systematic reviews have reported a decline in the incidence of major amputation in various countries and attributed this to improved multi-disciplinary care of the high-risk foot [1,3] This finding is consistent with recent analyses of data from the Australian population [4,20,22,23]. The age-and sex-adjusted incidence rates of major amputations in Queensland were reported to decrease by 26 % in the general population and 45 % in people with diabetes between 2005 to 2010 [4]. ...
Article
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Background This study estimated the incidence of major amputation for people in North Queensland, Australia, examined changes in amputation rates over time and investigated survival after major amputation. Methods This was a retrospective study of patients who underwent a major amputation above the ankle between 2000 and 2015. Major amputation rates and incidence rate ratios (IRR) were calculated using census data to define the at-risk population. Associations between risk factors and calendar year with major amputation were assessed using quasipoisson regression. Kaplan-Meier survival and Cox-proportional hazard analyses estimated the incidence of and risk factors for all-cause mortality. Results The annual incidence of major amputation was estimated to be greater in Aboriginal and Torres Strait Islanders than non-Indigenous people (IRR 2.75, 95 % CI 1.92 to 3.84). After adjusting for population growth, the annual incidence of major amputations did not change significantly over time for either groups. Aboriginal and Torres Strait Islander people were at greater risk of all-cause mortality after major amputation compared to non-Indigenous people, although this association was not significant after adjusting for other risk factors (hazard ratio 1.24, 95 % CI 0.82 to 1.90). Conclusions The incidence of major amputation in North Queensland has not reduced over time, indicating the need for better preventative treatments, particularly in Aboriginal and Torres Strait Islander people.