TO AMPUTATE OR NOT AMPUTATE? A RETROSPECTIVE COHORT STUDY EVALUATING COMPLICATIONS FOLLOWING AMPUTATION FOR CHRONIC TIBIAL AND FIBULAR OSTEOMYELITIS

AIM Chronic osteomyelitis is a severe bone infection that often requires surgical intervention, including amputation, when antibiotic therapy alone is insufficient. However, amputation carries its own risks, including significant morbidity and mortality. Research evaluating medical complications among patients with chronic osteomyelitis following amputation remains limited. This study aims to determine the five-year risk of complications, including delayed wound healing, sepsis, bacteremia, mortality, and long-term antibiotic and opioid use among patients with chronic osteomyelitis of the tibia or fibula who underwent lower extremity amputation compared to those who did not. METHODS Using CPT and ICD-10 codes, we queried the Global Collaborative Network on the TriNetX database on April 1, 2026 for patients with chronic osteomyelitis of the tibia or fibula between March 2006 and March 2026. Patients were stratified into two cohorts, those who underwent lower extremity amputation and those who did not. Patients with periprosthetic tibial fractures were excluded. 1:1 propensity score matching was performed to control for age, sex, race, type 2 diabetes mellitus, Human Immunodeficiency Virus, nicotine dependence, primary malignant neoplasm, and fracture of the lower leg, ankle, or tibial plateau. Five-year outcomes of long-term antibiotic use, opioid use, delayed wound healing, sepsis, bacteremia, and death were analyzed with exclusion of patients with outcomes prior to amputation. Risk difference, risk ratio, and Kaplan-Meier survival analyses were performed. P-value<0.05 was considered statistically significant. RESULTS After propensity matching, each cohort included 2,821 patients. Patients who underwent amputation experienced significantly higher risk of delayed wound healing, sepsis, and mortality compared to those without amputation (all p<0.05) (Table 1). On the other hand, risk of long-term antibiotic use was significantly higher in patients without amputation (p<0.001). There was no significant difference between groups in long-term opioid use or bacteremia. Kaplan-Meier analysis demonstrated a lower survival probability in the amputation group compared with the non-amputation group (62.58% vs. 70.56%; log-rank χ 2 =17.819, p<0.001). In an unadjusted Cox proportional hazards model, amputation was associated with an increased hazard of mortality (HR 1.27; 95% CI: 1.14-1.42, p<0.001). CONCLUSIONS Patients who underwent amputation for chronic osteomyelitis of the tibia or fibula demonstrated higher risks of delayed wound healing, sepsis, and mortality, but lower risks of long-term antibiotic use compared to patients without amputation. These findings emphasize the complex risk–benefit profile of lower extremity amputation and underscore the importance of careful patient selection, informed shared decision-making, and comprehensive perioperative risk stratification. For any tables or figures, please contact the authors directly.