{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:03:58Z","timestamp":1792541038090,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Diabetic foot disease is a major cause of lower-limb amputation and is associated with substantial morbidity and mortality. While amputation is often considered definitive treatment, postoperative outcomes and their predictors remain incompletely characterized. Materials and Methods: This retrospective cohort study included all patients who underwent diabetic foot amputation at a tertiary care center between January 2015 and August 2025. Demographic data, comorbidities, laboratory parameters, and amputation-related variables were collected. The primary outcome was postoperative complications. Secondary outcomes included readmission, re-amputation, ICU admission, length of stay, and mortality. Logistic regression was used to identify predictors of postoperative complications. Results: A total of 437 patients were included (mean age 62.0 \u00b1 11.8 years; 65.7% male). Postoperative complications occurred in 52.1% of patients, most commonly infections (31.6%) and acute kidney injury (18.1%). Readmission occurred in 50.6%, re-amputation in 23.4%, ICU admission in 28.7%, and mortality in 17.8%. On multivariable analysis, preoperative serum albumin was the only independent predictor of postoperative complications (aOR 0.944, 95% CI: 0.913\u20130.976; p &lt; 0.001). Conclusions: Postoperative complications following diabetic foot amputation are common and associated with significant healthcare utilization and mortality. Preoperative hypoalbuminemia was the only independent predictor of postoperative complications, supporting its utility as an integrated biomarker of systemic illness (including inflammatory burden\/infection and hepatic synthetic function) for perioperative risk stratification.<\/jats:p>","DOI":"10.3390\/medicina62030525","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:12:24Z","timestamp":1773321144000},"page":"525","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes and Laboratory Predictors of Complications Following Diabetic Foot Amputations: A Ten-Year Tertiary Care-Center Experience"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6034-9739","authenticated-orcid":false,"given":"Abdulrahman","family":"Alaseem","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8804-3743","authenticated-orcid":false,"given":"Mishari","family":"Alanezi","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8731-1008","authenticated-orcid":false,"given":"Othman","family":"Alabdullah","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8317-7640","authenticated-orcid":false,"given":"Mohamed Ibn","family":"Saqyan","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Almanea","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6676-8803","authenticated-orcid":false,"given":"Ibrahim","family":"Alshaygy","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Albishi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Francia, P., Gualdani, E., Policardo, L., Bocchi, L., Franconi, F., Francesconi, P., and Seghieri, G. (2022). Mortality Risk Associated with Diabetic Foot Complications in People with or without History of Diabetic Foot Hospitalizations. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092454"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7631659","DOI":"10.1155\/2018\/7631659","article-title":"Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study","volume":"2018","author":"Yazdanpanah","year":"2018","journal-title":"Int. J. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.1016\/S1078-5884(11)60012-9","article-title":"Chapter V: Diabetic foot","volume":"42","author":"Apelqvist","year":"2011","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/07853890.2016.1231932","article-title":"Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis","volume":"49","author":"Zhang","year":"2017","journal-title":"Ann. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/nyas.13569","article-title":"Update on management of diabetic foot ulcers","volume":"1411","author":"Everett","year":"2018","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1007\/s00125-012-2468-6","article-title":"Variation in the recorded incidence of amputation of the lower limb in England","volume":"55","author":"Holman","year":"2012","journal-title":"Diabetologia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.4239\/wjd.v12.i9.1401","article-title":"Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action","volume":"12","author":"Bidikian","year":"2021","journal-title":"World J. Diabetes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2174\/1573399811666150724095130","article-title":"Diabetes Mellitus in Saudi Arabia: A Review of the Recent Literature","volume":"12","author":"Robert","year":"2016","journal-title":"Curr. Diabetes Rev."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Fan, L., and Wu, X.J. (2021). Sex difference for the risk of amputation in diabetic patients: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0243797"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2761","DOI":"10.1590\/1518-8345.1203.2761","article-title":"Differences in foot self-care and lifestyle between men and women with diabetes mellitus","volume":"24","author":"Rossaneis","year":"2016","journal-title":"Rev. Lat. Am. Enfermagem."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"184","DOI":"10.34172\/jcs.2021.031","article-title":"Quality of Life and Self-care Activities in Diabetic Ulcer Patients, Grade 3: Gender Differences","volume":"10","author":"Polikandrioti","year":"2021","journal-title":"J. Caring Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2380337","DOI":"10.1155\/jdr\/2380337","article-title":"Age Characteristics of Patients With Type 2 Diabetic Foot Ulcers and Predictive Risk Factors for Lower Limb Amputation: A Population-Based Retrospective Study","volume":"2024","author":"Yao","year":"2024","journal-title":"J. Diabetes Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00590-025-04409-y","article-title":"Outcomes and risk factors for complications, readmissions, and reoperations following below-knee amputation: A comprehensive analysis beyond the 30-day window","volume":"35","author":"Bischoff","year":"2025","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s13018-025-05638-x","article-title":"Incidence, bacteriological profile and predictors of surgical site infections following limb amputation at Bugando medical centre and Sekou toure referral regional hospital, Mwanza, Tanzania","volume":"20","author":"Hamudu","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Dawi, J., Tumanyan, K., Tomas, K., Misakyan, Y., Gargaloyan, A., Gonzalez, E., Hammi, M., Tomas, S., and Venketaraman, V. (2025). Diabetic Foot Ulcers: Pathophysiology, Immune Dysregulation, and Emerging Therapeutic Strategies. Biomedicines, 13.","DOI":"10.3390\/biomedicines13051076"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"328","DOI":"10.12701\/jyms.2023.00731","article-title":"The pathophysiology of diabetic foot: A narrative review","volume":"40","author":"Kim","year":"2023","journal-title":"J. Yeungnam Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1097\/00007611-199108000-00009","article-title":"The diabetic foot: Consequences of delayed treatment and referral","volume":"84","author":"Mills","year":"1991","journal-title":"South. Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103174","DOI":"10.1016\/j.amsu.2021.103174","article-title":"Pattern and type of amputation and mortality rate associated with diabetic foot in Jeddah, Saudi Arabia: A retrospective Cohort Study","volume":"73","author":"Almohammadi","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"313","DOI":"10.2147\/DMSO.S165967","article-title":"Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome","volume":"11","author":"Shatnawi","year":"2018","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.avsg.2021.05.047","article-title":"Hypoalbuminemia is Associated with Mortality in Patients Undergoing Lower Extremity Amputation","volume":"77","author":"Chahrour","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/CORR.0000000000001455","article-title":"Is Reoperation Higher Than Expected after Below-the-knee Amputation? A Single-center Evaluation of Factors Associated with Reoperation at 1 Year","volume":"479","author":"Wong","year":"2021","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2340\/17453674.2024.42637","article-title":"Length of hospital stay and readmissions after major lower extremity amputation: A Danish nationwide registry study","volume":"95","author":"Brix","year":"2024","journal-title":"Acta Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jvs.2015.09.017","article-title":"Predictors of hospital readmissions after lower extremity amputations in Canada","volume":"63","author":"Kayssi","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1302\/1358-992X.2025.1.018","article-title":"Mortality, Re-Amputation, and Postoperative Complication Rates Following 28,000 Below-Knee Amputations in Diabetic Patients in England: A National Population Study, 2002\u20132022","volume":"107-B","author":"Hennessy","year":"2025","journal-title":"Orthop. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"111845","DOI":"10.1016\/j.diabres.2024.111845","article-title":"Advancements and best practices in diabetic foot Care: A comprehensive review of global progress","volume":"217","author":"Kumbhar","year":"2024","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1177\/193229681300700509","article-title":"Corneal confocal microscopy to assess diabetic neuropathy: An eye on the foot","volume":"7","author":"Tavakoli","year":"2013","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.2337\/db07-0285","article-title":"Surrogate markers of small fiber damage in human diabetic neuropathy","volume":"56","author":"Quattrini","year":"2007","journal-title":"Diabetes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S2213-8587(19)30081-6","article-title":"Diabetic peripheral neuropathy: Advances in diagnosis and strategies for screening and early intervention","volume":"7","author":"Selvarajah","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e70025","DOI":"10.1111\/jon.70025","article-title":"High-Field Diffusion Tensor Imaging of Median, Tibial, and Sural Nerves in Type 2 Diabetes With Morphometric Analysis","volume":"35","author":"Gabor","year":"2025","journal-title":"J. Neuroimaging"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/525\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:44:02Z","timestamp":1773326642000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030525"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030525","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}