Factors Associated with Major Versus Minor Lower Extremity Amputation in Hospitalized Patients with Diabetes in Saudi Arabia
4 affiliations
- 1College of Nursing, Northern Border University, Arar 73312, Saudi Arabia
- 2Medical Surgical Nursing Department, Al Noor Specialist Hospital, Makkah 24242, Saudi Arabia
- 3College of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- 4Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 13316, Saudi Arabia
Abstract
Background: Major lower extremity amputation (LEA) is a severe complication of diabetes with substantial disability and mortality. Evidence from Saudi Arabia with distinguishing factors linked to major versus minor amputation is limited. We examined demographic, clinical, vascular, and wound-related factors associated with amputation level among hospitalized patients with diabetes who had already undergone LEA. Methods: We conducted a retrospective comparative observational study of 230 adults with diabetes who underwent non-traumatic LEA at Al Noor Specialist Hospital, Makkah. Because the cohort comprised exclusively patients who had already undergone amputation, the analysis was explanatory in purpose and characterized factors associated with the level of amputation (major versus minor) rather than predictors of amputation occurrence in the broader population of patients with diabetic foot disease. Independent associations were examined using multivariable binary logistic regression with Firth’s penalization; adjusted odds ratios (aORs) with 95% confidence intervals were the principal results, and exploratory model diagnostics. Results: Major amputation occurred in 92 patients (40.0%); 138 (60.0%) underwent minor amputation. Mean age was 58.4 ± 12.6 years; 77.0% were male. After adjustment, ischemic heart disease (adjusted odds ratio [aOR] 5.20, 95% confidence interval [CI] 1.63–16.55), multiple foot ulcers (aOR 4.65, 95% CI 1.53–14.17), ulcer duration >1 month (aOR 3.15, 95% CI 1.09–9.10), and documented peripheral neuropathy (aOR 7.46, 95% CI 1.13–49.35) were independently associated with major amputation. The neuropathy estimate was imprecise, reflecting the small number of documented cases, and should therefore be regarded as highly uncertain. These exploratory associations describe the conditional comparison of amputation level within this operated cohort and should not be interpreted as individual probabilities of amputation or amputation level. Conclusions: Ischemic heart disease, multiple ulcers, prolonged ulcer duration, and documented peripheral neuropathy were associated with major amputation. These associations should be interpreted within the limits of a retrospective, single-center design with possible underascertainment of neuropathy and peripheral arterial disease. These exploratory findings require replication in independent, prospectively designed cohorts before they can be generalized to other settings or applied clinically.
Related
- Development and validation of a machine learning-based model for predicting amputation risk in patients with lower extremity arterial disease and diabetes
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- Prognostic Value of the Pan-Immune Inflammatory Value and Fibrinogen-To-Albumin Ratio for Amputation in Patients With Lower Extremity Arterial Disease
- Effectiveness of Human Cellular Umbilical Tissue Allograft Compared to Acellular Matrix Products in Managing Diabetic Lower Extremity Ulcers in Hospitalized Patients
- Chronic Pain and Residual Limb Outcomes Following Primary Major Lower Extremity Amputation vs. Minor-to-Major Amputation Progression: A Propensity Score-Matched Analysis
BibTeX
@article{mersal2026factors,
title = {{Factors Associated with Major Versus Minor Lower Extremity Amputation in Hospitalized Patients with Diabetes in Saudi Arabia}},
author = {Fathia Ahmed Mersal and Salma M. Alzarawi and Nahed A. Mersal and Ahmed Hazazi and Motab Aljohani and Sahal Alzahrani},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207946},
url = {https://www.mdpi.com/2077-0383/15/20/7946},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors Associated with Major Versus Minor Lower Extremity Amputation in Hospitalized Patients with Diabetes in Saudi Arabia
AU - Fathia Ahmed Mersal
AU - Salma M. Alzarawi
AU - Nahed A. Mersal
AU - Ahmed Hazazi
AU - Motab Aljohani
AU - Sahal Alzahrani
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207946
UR - https://www.mdpi.com/2077-0383/15/20/7946
AB - Background: Major lower extremity amputation (LEA) is a severe complication of diabetes with substantial disability and mortality. Evidence from Saudi Arabia with distinguishing factors linked to major versus minor amputation is limited. We examined demographic, clinical, vascular, and wound-related factors associated with amputation level among hospitalized patients with diabetes who had already undergone LEA. Methods: We conducted a retrospective comparative observational study of 230 adults with diabetes who underwent non-traumatic LEA at Al Noor Specialist Hospital, Makkah. Because the cohort comprised exclusively patients who had already undergone amputation, the analysis was explanatory in purpose and characterized factors associated with the level of amputation (major versus minor) rather than predictors of amputation occurrence in the broader population of patients with diabetic foot disease. Independent associations were examined using multivariable binary logistic regression with Firth’s penalization; adjusted odds ratios (aORs) with 95% confidence intervals were the principal results, and exploratory model diagnostics. Results: Major amputation occurred in 92 patients (40.0%); 138 (60.0%) underwent minor amputation. Mean age was 58.4 ± 12.6 years; 77.0% were male. After adjustment, ischemic heart disease (adjusted odds ratio [aOR] 5.20, 95% confidence interval [CI] 1.63–16.55), multiple foot ulcers (aOR 4.65, 95% CI 1.53–14.17), ulcer duration >1 month (aOR 3.15, 95% CI 1.09–9.10), and documented peripheral neuropathy (aOR 7.46, 95% CI 1.13–49.35) were independently associated with major amputation. The neuropathy estimate was imprecise, reflecting the small number of documented cases, and should therefore be regarded as highly uncertain. These exploratory associations describe the conditional comparison of amputation level within this operated cohort and should not be interpreted as individual probabilities of amputation or amputation level. Conclusions: Ischemic heart disease, multiple ulcers, prolonged ulcer duration, and documented peripheral neuropathy were associated with major amputation. These associations should be interpreted within the limits of a retrospective, single-center design with possible underascertainment of neuropathy and peripheral arterial disease. These exploratory findings require replication in independent, prospectively designed cohorts before they can be generalized to other settings or applied clinically.
SN - 2077-0383
ER -