Predictive Value of Preoperative Inflammatory and Nutritional Indices for Revision Surgery After Major Lower Extremity Amputation in Patients With Wagner Stage 5 Diabetic Foot.

BACKGROUND Major lower extremity amputation is a severe complication of diabetic foot disease, leading to high morbidity and repeat surgeries. Although systemic inflammatory and nutritional markers have been studied as prognostic factors in diabetic foot ulcers, their role in predicting revision surgery after major amputation is unclear. This study aims to evaluate the link between preoperative inflammatory and nutritional indices and revision surgery after major lower extremity amputation. MATERIAL AND METHODS This multicenter retrospective study reviewed medical records of patients with Wagner stage 5 diabetic foot disease who had major lower extremity amputation at 3 hospitals. Revision included stump shortening or re-amputation at a more proximal level. Patients were divided into revision and non-revision groups. Demographic characteristics, amputation side and level, and preoperative laboratory parameters were recorded. The Prognostic Nutritional Index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio were evaluated. Intergroup comparisons were performed to evaluate the association between these indices and the risk of revision surgery. RESULTS A total of 89 patients were studied; 35 (39.3%) needed revision surgery, while 54 (60.7%) healed successfully without further surgery. There were no significant differences between groups in age, sex, preoperative revascularization, amputation levels, laboratory parameters, or inflammatory and nutritional indices. No link was found between these indices and revision surgery. CONCLUSIONS Systemic inflammatory and nutritional indices before major lower extremity amputation in patients with diabetic foot were not linked to postoperative revision surgery. Risks may be more affected by local factors such as residual infection, limb perfusion, and stump viability. Future studies combining systemic biomarkers with vascular assessment could better predict revision risk.