Outcomes and Laboratory Predictors of Complications Following Diabetic Foot Amputations: A Ten-Year Tertiary Care-Center Experience

TL;DR

This study finds that low blood albumin levels before surgery predict complications after diabetic foot amputations, highlighting the importance of this biomarker for risk assessment.

Contribution

The study identifies preoperative serum albumin as the sole independent predictor of postoperative complications in diabetic foot amputations.

Findings

Postoperative complications occurred in 52.1% of patients, with infections and acute kidney injury being the most common.

Preoperative serum albumin was the only independent predictor of complications (aOR 0.944, 95% CI: 0.913–0.976; p < 0.001).

Mortality occurred in 17.8% of patients following diabetic foot amputations.

Abstract

Background and Objectives: Diabetic foot disease is a major cause of lower-limb amputation and is associated with substantial morbidity and mortality. While amputation is often considered definitive treatment, postoperative outcomes and their predictors remain incompletely characterized. Materials and Methods: This retrospective cohort study included all patients who underwent diabetic foot amputation at a tertiary care center between January 2015 and August 2025. Demographic data, comorbidities, laboratory parameters, and amputation-related variables were collected. The primary outcome was postoperative complications. Secondary outcomes included readmission, re-amputation, ICU admission, length of stay, and mortality. Logistic regression was used to identify predictors of postoperative complications. Results: A total of 437 patients were included (mean age 62.0 ± 11.8 years; 65.7% male). Postoperative complications occurred in 52.1% of patients, most commonly infections (31.6%) and acute kidney injury (18.1%). Readmission occurred in 50.6%, re-amputation in 23.4%, ICU admission in 28.7%, and mortality in 17.8%. On multivariable analysis, preoperative serum albumin was the only independent predictor of postoperative complications (aOR 0.944, 95% CI: 0.913–0.976; p < 0.001). Conclusions: Postoperative complications following diabetic foot amputation are common and associated with significant healthcare utilization and mortality. Preoperative hypoalbuminemia was the only independent predictor of postoperative complications, supporting its utility as an integrated biomarker of systemic illness (including inflammatory burden/infection and hepatic synthetic function) for perioperative risk stratification.

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