Risk factors for re-amputation and major amputation following diabetic foot amputation: a clinical and socioeconomic perspective

Diabetic foot amputation (DFA) is a severe complication of diabetes mellitus, and many patients require subsequent procedures because of recurrence or progression of ischemia. Although the clinical predictors of amputation have been extensively studied, the influence of social factors remains underexplored in Asian populations. This retrospective cohort included 155 patients with diabetic foot ulcers who presented between 2024 and 2025 and had undergone surgical amputation. Immediate in-hospital revision procedures were excluded, as these were considered part of the initial surgical episode rather than true re-amputation. Amputations were categorized as minor or major. Group comparisons were performed using t-tests or chi-square tests, and variables with p < 0.10 in univariate analyses were entered into multivariate logistic regression to identify independent predictors of re-amputation and major amputation. Kaplan–Meier survival analysis and Cox proportional hazards regression were additionally performed to evaluate time to re-amputation. The re-amputation rate was 52.3%, and major amputations occurred in 14.2%. On multivariate analysis, higher BMI and marital status predicted re-amputation. For major amputation, insulin or combined therapy, and marital status were predictors. Elevated CRP and WBC levels were associated with major amputation in univariate analyses but lost significance after adjustment. Both clinical and social determinants influenced adverse outcomes following DFA, with marital status consistently predicting both re-amputation and major amputation.