Introduction and Objective: Hospital management of diabetic foot ulcers (DFU) is increasingly shifting toward less invasive, bedside-based strategies. In 2016, our unit implemented routine blind bone biopsy (B4), bedside toe amputation surgery (BTAS) performed by diabetologists and increased use of limb revascularization (RVZ). We evaluated the impact of this practice change on lower limb amputation (LLA) rates. Methods: This monocentric observational study compared outcomes before (2013-2015) and after (2023-2025) implementation. A total of 761 patients hospitalized for DFU were included (2013-2015: n = 280; 2023-2025: n = 481). Major amputations were defined as transtibial or transfemoral. Baseline characteristics, DFU severity (SINBAD score) and amputation setting were analyzed. Multivariate logistic regression assessed associations between B4, BTAS, RVZ, and LLA outcomes. Results: Baseline characteristics and DFU severity were comparable between periods (median SINBAD score: 4). Overall, 57% of DFUs involved one or two toes, with necrosis present in 58%. Compared with 2013-2015, 2023-2025 showed significant reductions in total LLA (52% vs 33%; p = 5.10-7), major LLA (21.1% vs 9.8%; p = 0.0007) and amputations performed in the operating room (47% vs 14%; p = 1.10-22). In multivariate analysis, B4 and BTAS were independently associated with lower LLA rates, whereas RVZ was not. Conclusion: Diabetologist-led bedside bone biopsy and toe amputation surgery were associated with significant reductions in overall (-30%) and major LLA (-54%) and decreased operating room use (-70%) in hospitalized DFU patients. Disclosure J. Kevorkian: None. F. Feron: None. J. Julla: Board Member; Current; Sanofi. Consultant; Current; Sanofi, IQVIA Inc. Other - Speaker; Ended; Novo Nordisk. Other - Facility; Ended; Lilly Diabetes. J. Gautier: None.
KEVORKIAN et al. (Fri,) studied this question.