Minor vs. major leg amputation in adults with diabetes: Six-month readmissions, reamputations, and complications

Aims: The objective of this study was comparing medium-term outcomes between comparable minor and major amputations in adults with diabetes. Methods: We used data from the 2016–2017 National Readmissions Database to construct a representative cohort of 15,581 adults with diabetes with lower extremity amputations. Patients were categorized by level of index amputation (major/minor), and propensity score matched to compare outcomes in candidates for either level of amputation. Readmission and reamputations were assessed at 1, 3, and 6 months following index amputation. Results: In the 6 months following index amputation, large proportions of patients were readmitted (n = 7597, 48.8%) or had reamputations (n = 1990, 12.8%). Patients with minor amputations had greater odds of readmission (OR = 1.25; 95% CI 1.18–1.31), reamputation (OR = 3.71; 95% CI 3.34–4.12), and more proximal reamputation (OR = 2.61; 95% 2.33–2.93) (all P < 0.001). Further, minor amputation patients had higher and lower odds of readmission for postoperative infection (OR = 4.45; 95% CI 3.27–6.05), or sepsis (OR = 0.79; 95% CI 0.68–0.93), respectively. Conclusion: Patients desire to save as much limb as possible and should be counseled on higher risk for reamputation, readmission, and infection with minor amputations.