---
title: "Diabetes and 30-Day Outcomes After Below-Knee Amputation: Complications, Readmission, Reoperation"
id: "pubmed-42723462"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42723462"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42723462/"
doi: "10.1177/19386400261484263"
published_at: "2026-09-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Diabetes and 30-Day Outcomes After Below-Knee Amputation: Complications, Readmission, Reoperation
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42723462
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42723462/)
- **DOI:** [10.1177/19386400261484263](https://doi.org/10.1177%2F19386400261484263)
- **Published At:** 2026-09-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective cohort study used the ACS NSQIP database (2005–2019) to identify 28,776 patients who underwent **below-knee amputation** (CPT 27880, 27881, 27882). Of these, 20,310 (70.6%) had **diabetes**. - The analysis compared 30-day postoperative outcomes between diabetic and nondiabetic patients, including overall complications, severe complications, readmission, reoperation, mortality, and discharge destination. - Diabetic patients had higher 30-day complication rates (39.0% vs 34.8%; P < .001) and higher severe complication rates (9.12% vs 8.20%; P = .012) compared with nondiabetic patients. - Specific complications more common in diabetic patients included **bleeding requiring transfusion** (20.4% vs 15.0%; P < .001) and **sepsis** (6.28% vs 5.23%; P < .001). - Multivariate analysis found diabetes independently predicted increased odds of adverse discharge to a facility (OR 1.184; P < .001) but was associated with decreased odds of reoperation (OR 0.785; P < .001) and decreased odds of 30-day mortality (OR 0.809; P = .002). - Within the diabetic subgroup, **insulin-dependent** patients had higher rates of any postoperative complication (39.7% vs 36.4%; P < .001), higher readmission (14.1% vs 12.1%; P = .005), and longer length of stay (12.4 vs 11.6 days; P = .007) compared to noninsulin diabetic patients. - The authors conclude diabetic patients undergoing BKA have increased 30-day complications and adverse discharge, though lower adjusted odds of reoperation and mortality; they recommend targeted perioperative optimization given elevated bleeding-transfusion and sepsis rates. - Study design: Level III retrospective cohort study. Database years, cohort size, outcome measures, and statistical results are reported in the source.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Effect of Diabetes on 30-Day Complications, Readmission, and Reoperation in Patients Undergoing Below-Knee Amputation [Solangel Rodriguez Materon](https://pubmed.ncbi.nlm.nih.gov/?term=Rodriguez+Materon+S&cauthor_id=42723462)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#full-view-affiliation-1 "Foot and Ankle Orthopaedic Surgery, Baptist Health South Florida, Coral Gables, Florida."), [Samantha Trynz](https://pubmed.ncbi.nlm.nih.gov/?term=Trynz+S&cauthor_id=42723462)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#full-view-affiliation-2 "Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina."), [Joshua Morningstar](https://pubmed.ncbi.nlm.nih.gov/?term=Morningstar+J&cauthor_id=42723462)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#full-view-affiliation-3 "University of North Carolina School of Medicine, Chapel Hill, North Carolina."), [Dev Patel](https://pubmed.ncbi.nlm.nih.gov/?term=Patel+D&cauthor_id=42723462)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#full-view-affiliation-4 "Memorial Healthcare System, Hollywood, Florida."), [Daniel J Scott](https://pubmed.ncbi.nlm.nih.gov/?term=Scott+DJ&cauthor_id=42723462)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#full-view-affiliation-2 "Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina."), [Christopher E Gross](https://pubmed.ncbi.nlm.nih.gov/?term=Gross+CE&cauthor_id=42723462)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#full-view-affiliation-2 "Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina.") Affiliations Expand ### Affiliations * 1 Foot and Ankle Orthopaedic Surgery, Baptist Health South Florida, Coral Gables, Florida. * 2 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina. * 3 University of North Carolina School of Medicine, Chapel Hill, North Carolina. * 4 Memorial Healthcare System, Hollywood, Florida. * PMID: **42723462** * DOI: [ 10.1177/19386400261484263 ](https://doi.org/10.1177/19386400261484263) Item in Clipboard # Effect of Diabetes on 30-Day Complications, Readmission, and Reoperation in Patients Undergoing Below-Knee Amputation Solangel Rodriguez Materon et al. Foot Ankle Spec. 2026. Show details Display options Display options Format Abstract PubMed PMID Foot Ankle Spec Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Foot+Ankle+Spec%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Foot+Ankle+Spec%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42723462/) . 2026 Sep 11:19386400261484263. doi: 10.1177/19386400261484263. Online ahead of print. ### Authors [Solangel Rodriguez Materon](https://pubmed.ncbi.nlm.nih.gov/?term=Rodriguez+Materon+S&cauthor_id=42723462)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#short-view-affiliation-1 "Foot and Ankle Orthopaedic Surgery, Baptist Health South Florida, Coral Gables, Florida."), [Samantha Trynz](https://pubmed.ncbi.nlm.nih.gov/?term=Trynz+S&cauthor_id=42723462)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#short-view-affiliation-2 "Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina."), [Joshua Morningstar](https://pubmed.ncbi.nlm.nih.gov/?term=Morningstar+J&cauthor_id=42723462)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#short-view-affiliation-3 "University of North Carolina School of Medicine, Chapel Hill, North Carolina."), [Dev Patel](https://pubmed.ncbi.nlm.nih.gov/?term=Patel+D&cauthor_id=42723462)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#short-view-affiliation-4 "Memorial Healthcare System, Hollywood, Florida."), [Daniel J Scott](https://pubmed.ncbi.nlm.nih.gov/?term=Scott+DJ&cauthor_id=42723462)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#short-view-affiliation-2 "Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina."), [Christopher E Gross](https://pubmed.ncbi.nlm.nih.gov/?term=Gross+CE&cauthor_id=42723462)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42723462/#short-view-affiliation-2 "Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina.") ### Affiliations * 1 Foot and Ankle Orthopaedic Surgery, Baptist Health South Florida, Coral Gables, Florida. * 2 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina. * 3 University of North Carolina School of Medicine, Chapel Hill, North Carolina. * 4 Memorial Healthcare System, Hollywood, Florida. * PMID: **42723462** * DOI: [ 10.1177/19386400261484263 ](https://doi.org/10.1177/19386400261484263) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract IntroductionRisk 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.MethodsThe 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.ResultsPostoperatively, 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.ConclusionDiabetic 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_. **Keywords:** below knee amputation; diabetic; outcomes; risk factors. 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