Emergency Hospitalization, Amputation, and Survival After Charcot Neuro-Osteoarthropathy Diagnosis in People With Diabetes: A Regional Registry-Based Cohort Study

OBJECTIVE The aim for this study was to describe adverse outcomes after Charcot neuro-osteoarthropathy (CNO) diagnosis in adults with diabetes and examine variation by clinical and sociodemographic characteristics. RESEARCH DESIGN AND METHODS A regional, registry-based cohort study was conducted using linked routinely collected health care data from adults with diabetes and a first recorded CNO diagnosis in the National Health Service Greater Glasgow and Clyde, Scotland (2015–2024). Outcomes were all-cause emergency hospitalization, lower-extremity amputation, all-cause mortality, and amputation-free survival. Time-to-event methods and multivariable regression were used to estimate event probabilities and tested associations with clinical characteristics. RESULTS From 127,513 adults with diabetes, 140 individuals with a first recorded CNO diagnosis were identified; their mean age was 59 years, and 67% were men. During a median 4.6-year follow-up, 123 patients (87.9%) had an emergency admission, 44 (31.4%) underwent lower-extremity amputation (minor or major), and 53 (37.9%) died. The estimated 5-year survival was 67%, while 5-year amputation-free survival was 44% (median 4.04 years). Advanced chronic kidney disease (stages 4 and 5) was associated with higher risk across outcomes. High or active foot-risk status was independently associated with lower-extremity amputation (subdistribution hazard ratio 8.52; 95% CI 2.05–35.45) and shorter amputation-free survival (hazard ratio (HR) 2.09; 95% CI 1.15–3.80), and older age was independently associated with higher mortality rate (HR 3.04; 95% CI 1.50–6.16). CONCLUSIONS Adverse outcomes in CNO were frequent and occurred early after diagnosis, with high rates of emergency hospitalization, amputation, and death. These findings support CNO as a marker of systemic vulnerability and highlight the need for prioritized surveillance and multidisciplinary management in routine clinical care.