Do Immediate Perioperative Glucose Measurements Predict Outcomes in Non-Elective Pedal Amputation?

Abstract

Background

Approximately 20% of diabetic foot ulcers progress to amputation. While elevated glucose levels are known to increase infection risk in elective surgeries, their role in outcomes following non-elective amputation remains unclear. Methods. We conducted a 2-year retrospective chart review of adult patients who underwent non-elective, diabetes-related lower-extremity amputations at a tertiary care health system. Of 185 charts reviewed, 108 patients with at least 6 months of follow-up were included. Preoperative and immediate postoperative glucose values were recorded. Primary and secondary outcomes included healing time, postoperative infection, emergency department visits, and hospital readmissions. Multivariable regression models were used to adjust for patient sex, amputation level, and relevant comorbidities.

Results

The mean healing time was 13.8 weeks (SD 12.9). Elevated perioperative glucose (>180 mg/dL) was associated with a 42% increase in healing time (P = .037). Postoperative infections occurred in 14.8% of patients and were associated with an almost two-fold increase in healing time (P=.001), as well as increased rates of emergency department visits and readmissions. Peripheral arterial disease and end-stage renal disease were independently associated with delayed healing and higher readmission rates.

Conclusion

Elevated perioperative glucose levels, postoperative infection, peripheral arterial disease, and end-stage renal disease are associated with prolonged wound healing and higher complication rates after non-elective lower-extremity amputations in patients with diabetes. These findings underscore the importance of perioperative glucose optimization, infection prevention, and comprehensive management of comorbidities to improve surgical outcomes in this high-risk population.