Traditional Methods of Health Education are not enough to Reduce Major Lower Limb Amputations in Trinidad & Tobago; A Seven Year Retrospective Study

Abstract

Background: Major lower extremity amputation is defined as any amputation of the limb performed above the level of the ankle. Indications often include severe infection, ischemia, trauma and tumours. Total amputation rate in Trinidad and Tobago (T&T) is not yet known. Data is only available from a single center in Trinidad and Tobago over a two year period and not from the entire country and the number of total amputation was based on simple speculation and general estimate. The aim of this study is to first time document the exact annual amputation rate in T&T with their demographic characteristics and also to find out whether the existing methods of health education are effective in reducing amputations. Methods: A retrospective review of all lower limb amputations was performed in all 5 public hospitals in Trinidad and Tobago from January 2012 to December 2018. Annual major lower limb amputations in the 10 private hospitals were also documented. Data collected on patients demographics included patient’s age, sex, race, and amputation type. Results: A total of 3586 (85.87%) major lower limb amputations were performed in the public and 590 (14.13%) in the private hospitals over our 7 year study period. The average annual major lower limb amputation rate in T&T is about 600 (596.5) with an average daily rate of 1.63. The mean age of our study group was 65.7 (23-103) years with a male to female ratio of 1.2:1. Afro Trinidadian accounted for 1962 (47%), Indo Trinidadian 1899 (42%) and other 11%. The predominant type of amputations was above knee 55.06% (n=2299) compared to below knee 44.94% (n=1877). Diabetic foot complications accounted for the majority of amputations in this study. The amputation rate has not declined over the years; rather there has been an annual increase over the study. Conclusions: The annual major lower limb amputation rate in T&T is significantly higher than previous estimates. This is very costly in the context of our limited resources and alarming on our already exhausted economy. This study shows that diabetes and peripheral vascular disease continue to be major risk factors for lower limb amputations: this negatively impacts the overall health of our society. Current methods have failed to reduce amputations. We recommend an integrated multidisciplinary approach involving doctors, diabetic nurse counselors, dieticians, podiatrists, physiotherapists, social welfare officers, politicians, religious leaders and social scientists. Continued education on diabetes, its complications and foot care as well as modifications of current methods are essential to minimize limb loss.