A framework for the hospital burden of diabetic foot and lower-limb amputation in Chile

Introduction: Diabetic foot and lower-limb amputation are the most disabling end stage of diabetes, yet their joint hospital burden has not been characterized in Chile as an integrated framework. Methods: Ecological time-series analysis of 26,348,569 national hospital discharges between 2004 and 2019 from the open DEIS microdata mirror (Universidad de Chile repository, CC-BY 4.0). Diabetic foot was a main diagnosis in E10.5-E14.5 and lower-limb amputation a principal surgical procedure code from toe to hip. Crude rates used World Bank population estimates and average annual percent change was estimated by Poisson regression. Results: The period recorded 126,169 diabetic foot discharges and 74,414 lower-limb amputations. The diabetic foot rate rose from 32.9 to 48.6 per 100,000 inhabitants (AAPC 3.5%; 95% CI 3.4-3.7) and the amputation rate from 11.9 to 32.7 (AAPC 7.2%; 95% CI 7.0-7.3). Men contributed 71.2% of diabetic foot and 72.0% of amputation discharges, persons aged 65 years or older concentrated half of the burden, and the Metropolitana region accumulated 32.1% of diabetic foot discharges while Nuble showed the highest internal rate. Major amputations carried 8.0% in-hospital mortality. Conclusions: Diabetic foot and lower-limb amputation discharges grew continuously between 2004 and 2019, concentrated in men, older adults and specific regions, and the amputation burden rose faster than the diabetic foot burden. These temporal, demographic, geographic and clinical components integrate into one framework of the diabetic foot and amputation pathway.