Risk factors and mortality for amputations in the diabetic foot: a nationwide cohort study

To investigate risk factors and mortality associated with major amputations in people with diabetic foot ulcers (DFUs), and to differentiate them from minor amputations.

We conducted a nationwide, retrospective longitudinal study using cohort data from the Korean National Health Insurance Service (2002-2020), including people with DFUs who underwent lower extremity amputation. People were categorized into minor and major amputation groups. Comparative analyses were conducted using variables available from health insurance data.

Among 40,809 people with DFU-related amputations, the major amputation group showed a higher proportion of males, older age, and lower income. Revascularization procedures and use of top-tier antibiotics were more common in the major group. Comorbidities such as end-stage renal disease (ESRD), dementia, cerebrovascular disease, and ischemic heart disease were also more frequent (P < 0.001). The major group had higher mortality (73.9 % vs. 52.2 %) and shorter survival (986 vs. 1209 days). Dementia, ESRD, and prior major amputation had the highest adjusted hazard ratios for mortality.

Major amputation in people with DFUs is associated with advanced age, vascular disease, comorbidities, and increased mortality. In contrast, minor amputation is linked to better survival. Limb-sparing approaches may improve long-term outcomes in this high-risk population.