Effect of Diabetes on 30-Day Complications, Readmission, and Reoperation in Patients Undergoing Below-Knee Amputation

Introduction Risk factors for early complications and reoperation in the overall population undergoing below-knee amputation (BKA) have been reported; however, there is limited literature investigating adverse postoperative outcomes specific to diabetic patients. This study compares 30-day complication, readmission, reoperation, and mortality rates following BKA in patients with and without diabetes. Methods The ACS NSQIP database was queried from 2005 to 2019 to identify 28 776 patients undergoing BKA using current procedural terminology (CPT) codes 27880, 27881, and 27882. Of this cohort, 20 310 (70.6%) had diabetes. Postoperative outcomes, including 30-day complications, readmission, reoperation, and mortality, were compared between groups. Results Postoperatively, diabetic patients had significantly higher rates of 30-day complications (Diabetic = 39.0%, Nondiabetic = 34.8%; P < .001), including severe complications (Diabetic = 9.12%, Nondiabetic = 8.20%; P = .012). Diabetic patients also had significantly higher rates of bleeding requiring transfusion (Diabetic = 20.4%, Nondiabetic = 15.0%; P < .001) and sepsis (Diabetic = 6.28%, Nondiabetic = 5.23%; P < .001). On multivariate analysis, diabetes independently predicted increased risk of adverse discharge to a facility (defined as discharge to a skilled nursing or rehabilitation facility rather than home; odds ratio [OR] 1.184; P < .001) but decreased odds of reoperation (OR 0.785; P < .001) and mortality (OR 0.809; P = .002). Among diabetic patients, insulin-dependent diabetic patients experienced significantly higher rates of any postoperative complication (Insulin = 39.7%, Noninsulin = 36.4%; P < .001) and readmission (Insulin = 14.1%; Noninsulin = 12.1%; P = .005), as well as increased length of stay (Insulin = 12.4 days; Noninsulin = 11.6 days; P = .007) compared to other diabetics. Conclusion Diabetic patients undergoing BKA had significantly increased rates of 30-day complications, including severe complications, and adverse discharge to a facility. However, diabetes was independently associated with decreased odds of reoperation and mortality within 30 days. Insulin-dependent diabetic patients experienced further elevated complication and readmission rates. Given the significantly increased rates of bleeding requiring transfusion and sepsis among diabetic patients, targeted perioperative optimization strategies should be employed in this population. Level of Evidence: Level III retrospective cohort study