Objective: Since the seminal publication by Hennis et al that established Barbados as the amputation capitol of the world, there have been numerous initiatives to decrease the incidence of diabetes and diminish leg amputations by establishing better primary care programmes and improving public awareness. The industrialized world has experienced a 20 to 75% reduction in the incidence of major amputations during the past two decades. We hypothesized that the implementation of these global strategies would also significantly reduce the rate of amputations in Barbados.
Method: A retrospective analysis was undertaken of patients who underwent a lower extremity amputation (LEA) between January 1 and December 31, 2009 at the Queen Elizabeth and Bay View Hospitals by the review of the operating logs and under the guidance of the Ethics Board.
Results: A total of 226 LEA were performed in 2009 similar to the number performed in 1999. Diabetes was present in 85% of the amputees in 2009 compared to only 75% in 1999. The location of the LEA is shown in the Table.
Conclusion: Despite public health and care-giver diabetes initiatives, there has been no improvement in leg amputations in Barbados. The data suggest that there may be an alarming worsening of the situation because although the numbers of LEA are similar over the decade, there is a much higher percentage of patients with diabetes. Furthermore, there is also a disturbing trend in 2009, with a lower number of minor amputations mirrored by a dramatic increase in proximal leg amputations (AKA/BKA). This may indicate that patients are presenting to their physicians at a later stage of their foot pathology. Further attempts at patient education and establishment of foot screening clinics may be required to reverse this trend.