Risk factors associated with increased mortality in patients with supracondylar amputation secondary to diabetic foot

Diabetes is a public health problem that has been increasing in recent years. Infected diabetic foot is established by the presence of inflammatory response data associated with ulcers or tissue loss. Multiple risk factors are associated with diabetic foot and the need for amputation secondary to infection.

Retrospective observational cohort study conducted between 2019 and 2024. A total of 403 patients with supracondylar amputation secondary to soft tissue infection due to diabetic foot were included. Demographic, clinical, and biochemical variables were analyzed between deceased and surviving patients.

A total of 403 patients were included (median age: 58 years, IQR: 50-67; 72.7% male). Overall, in-hospital mortality was 13.4% (54/403), primarily driven by septic shock (44.4%) and decompensated chronic kidney disease (33.3%). Surgical reintervention was required in 11.1% of cases. In multivariable analysis, age (OR=1.06), pre-existing cardiac disease (OR=7.17), bilateral amputation (OR=4.36), Clavien-Dindo complication grade (OR=2.67), and surgical reintervention (OR=6.46) were independently associated with higher in-hospital mortality. Baseline serum albumin exerted a protective effect (OR=0.20).

In-hospital mortality following supracondylar amputation for diabetic foot is independently associated with acute septic burden, admission hypoalbuminemia, cardiorenal comorbidity, and surgical reintervention, rather than long-term glycemic control. Early identification of this high-risk profile at admission is critical to prioritize prompt infection control and perioperative optimization.