Factors Associated with Major Versus Minor Lower Extremity Amputation in Hospitalized Patients with Diabetes in Saudi Arabia

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.