Frostbite in January — Amputate in July: Is watchful waiting for surgical management following frostbite injury still standard? An examination of the National Readmission Database

Frostbite injuries account for 2000–4000 hospital admissions annually in the U.S., with 30% of severe cases requiring amputation and up to 70% result in long-term sequelae or disability. Traditional practice following frostbite injury is to delay surgical intervention 4–6 weeks to preserve limb length, tissue coverage, and reduce complications. This study examines amputation timing among frostbite patients in the U.S. and identifies factors influencing early versus delayed amputation. This retrospective study used the Nationwide Readmission Database from 2016–2020 to identify frostbite admissions. Logistic regression models identified predictors of early amputation. Among 4786 patients with frostbite injury, 1422 (29.7%) underwent amputation. Of these, 977 (68.7%) had early amputations. Drug and alcohol use and housing insecurity were more prevalent among amputated patients, but was not associated with early amputation. Female sex, drug or alcohol use, comorbidities, infection or cellulitis, and mental health diagnoses were associated with a lower likelihood of early amputation. In adjusted models, infection/cellulitis was associated with lower odds of early amputation in the full cohort and not associated with timing in the non-elective subset. Across U.S. admissions captured in the NRD, amputations commonly occurred within 30 days of presentation, diverging from historical “watchful waiting” practices. Social drivers of health influence need for and timing of amputations. Infection and cellulitis, which may necessitate urgent intervention, was not associated with increased likelihood of early amputation timing. Future research should explore factors driving early amputation and assess the impact of amputation timing on functional outcomes.