Clinical frailty scale as a tool to predict outcomes after lower extremity amputation among patients with diabetes: A retrospective cohort study

Aims: The primary aim of this study was to investigate how the Clinical Frailty Scale (CFS) associates with survival of patients with diabetes after lower extremity amputation (LEA). Methods: This retrospective cohort study included patients with diabetes undergoing nontraumatic LEA at Tampere University Hospital during 2007–2020. Kaplan-Meier and Cox regression analyses were performed to evaluate the effect of CFS on overall survival (OS), amputation-free survival (AFS) and leg salvage (LS). Results: A total of 1043 patients with mean age 71.0 years were included. Compared to patients with low CFS (1, 2), scores 3–4 and 5–9 were associated with reduced OS (HR 1.821, p < 0.001; HR 4.585, p < 0.001), AFS (HR 1.575, p < 0.001; HR 4.031, p < 0.001) and LS (HR 1.435, p = 0.049; HR 2.478, p < 0.001). The multivariable Cox regression analysis showed that CFS remained a significant predictor of OS, AFS and LS. Conclusions: This study demonstrates a high prevalence of frailty among patients with diabetes undergoing LEA, suggesting that frailty assessment should be integrated into clinical decision-making for this patient population. The CFS score appears to be a promising tool for evaluating patients facing amputation to enhance survival rates.