The Risk of and Associated Demographic and Laboratory Variables for Amputations for Inpatients with Diabetic Foot Ulcers

Objectives Diabetic foot ulcers (DFU) are a leading cause of morbidity and mortality which disproportionately impacts underserved populations. This study seeks to provide data regarding the rates and outcomes of amputation in patients admitted with DFU in our health system which cares for an ethnically diverse and underserved population. Methods This retrospective study examined the electronic medical records of adult patients hospitalized with DFU at three hospitals in our health system between 06/01/2016 and 05/31/2021. Results Among 650 patients admitted for DFU, 88% self-identified as non-White race. Male sex (OR 0.62), low BMI (OR 0.98), and history of smoking (OR 1.45) were significantly associated with amputation during the study period. Higher erythrocyte sedimentation rate (OR 1.01), C-reactive protein (OR 1.05), white blood cells (OR 1.11), and low albumin (OR 0.41) were found to be significantly associated with amputation versus no amputation during admission. The amputation risk during the index admission for DFU was 44%. Conclusion Our study identified a high DFU-related amputation risk (44%) among adult patients who were mostly Black and/or Hispanic. The significant risks factors associated with DFU amputation included male sex, low BMI, smoking as well as high levels inflammation or low levels of albumin during admission. Many of these patients required multi-disciplinary care and intravenous antibiotic therapy, requiring a longer length of stay and a high rate of readmission.