To investigate the impact of different amputation timings on the prognosis of elderly patients with diabetic foot after failed limb salvage therapy, and to provide evidence for optimizing clinical decision-making regarding amputation.

A retrospective analysis was conducted on the clinical data of 37 elderly patients with diabetic foot who underwent amputation after failed limb salvage therapy in the Department of Hand and Foot Surgery of our hospital from January 2022 to December 2024. According to the timing of amputation, patients were divided into an early amputation group (surgery within 72 hours after failed limb salvage, n=16) and a delayed amputation group (surgery more than 72 hours after failed limb salvage, n=21). T test or χ² test was used to compare the differences in incidence of postoperative complications, wound healing time, hospital stay, 6-month survival rate, and quality of life (SF-36) scores between the two groups. Multivariate Logistic regression analysis was used to identify risk factors affecting prognosis.

The total postoperative complication rates in the early amputation group and the delayed amputation group were 31.25% and 66.67% respectively, with a statistically significant difference (χ²=5.231, P < 0.05). The wound healing time and hospital stay in the early amputation group were (28.6±5.2) days and (35.2±8.7) days respectively, while those in the delayed amputation group were (42.5±7.8) days and (52.6±10.3) days, respectively. The differences were statistically significant between the two groups (t=6.325, 5.871; P < 0.01). At 6 months after surgery, the survival rate and quality of life score in the early amputation group were 93.75% and (68.5±10.2) points, respectively, while those in the delayed amputation group were 71.43% and (52.3±8.6) points, respectively. The differences were statistically significant between the two groups (χ²=3.968, t=5.124; P < 0.05 or P < 0.01). Multivariate Logistic regression analysis showed that delayed amputation timing, preoperative severe infection, and poor nutritional status were independent risk factors for poor prognosis (OR=3.852, 4.218, 3.526; 95%CI: 1.215~12.163, 1.356~13.132, 1.087~11.445; P < 0.05).

For elderly patients with diabetic foot after failed limb salvage therapy, early amputation (within 72 hours) under relatively stable conditions can reduce the incidence of postoperative complications, shorten wound healing time and hospital stay, and improve survival rates and quality of life, making it worthy of clinical promotion.