Risk Factors for Amputation in Diabetic Foot Ulcers: A Retrospective Analysis

INTRODUCTION: This study aims to identify the risk factors contributing to minor and major amputations in patients undergoing amputation due to diabetic foot, analyze the differences between these two groups, and develop strategies to prevent amputation progression.
METHODS: This retrospective observational study included 337 patients who underwent amputation due to diabetic foot at the Chronic Wound Unit of Ankara Bilkent City Hospital between April 15, 2022, and December 31, 2024. Demographic data, comorbidities, clinical characteristics, and laboratory findings of the patients were evaluated. Statistical analyses were performed using the Mann-Whitney U test, Chi-square test, and Fisher’s exact test. A p-value of <0.05 was considered statistically significant.
RESULTS: Among the study population, 221 patients underwent minor amputation, while 116 patients underwent major amputation. The mean age was significantly higher in the major amputation group (p=0.043). The length of hospital stay was also significantly longer in this group (p=0.019). Peripheral artery disease (p<0.001), chronic kidney disease (p=0.001), and congestive heart disease (p=0.001) were significantly more prevalent in the major amputation group. Osteomyelitis (p=0.002) and gangrene (p<0.001) were strongly associated with major amputation. Although HbA1c levels were higher in the minor amputation group (p=0.022), hemoglobin and glomerular filtration rate were significantly lower (p<0.001, p=0.0019). White blood cell, urea, and creatinine levels were significantly higher in the major amputation group (p=0.031, p=0.013, p=0.005).
DISCUSSION AND CONCLUSION: Advanced age, peripheral artery disease, congestive heart disease, presence of infection, and elevated inflammatory markers are significant predictors of major amputation. Early diagnosis, vascular assessment, and infection control play a crucial role in reducing amputation rates in diabetic foot patients. Close monitoring of patients with PAD and CKD, along with the implementation of early intervention strategies, is essential in minimizing the risk of major amputation.