Financial and functional outcomes in diabetes-related foot disease patients undergoing major lower limb amputation: An observational pilot study from LMIC

Background and Objectives: Major lower limb amputation poses significant financial and emotional challenges especially in diabetic patients. This study aimed to assess the financial and functional outcomes of patients with Diabetic foot disease who underwent major lower limb amputations. Methodology: This prospective cohort study was conducted at a tertiary care hospital in Pakistan, including Diabetic foot disease patients who underwent major lower limb amputations. A validated questionnaire assessing functional and financial outcomes was administered via telephone six months post-surgery. Results: The mean age of 41 patients was 54.8±14.6 years with 31 (75.6%) being male. Sepsis was the primary indication for major lower limb amputations (n=15/41, 36.6%). Following MLLA, 50% (n=13/26) of the patients lost their jobs, and only 15.4% (n=4/26) received paid leave. The median cost of prosthetics/crutches (PKR 154,000) far exceeded the average monthly income of patients. Only 17.1% (n=7/41) of patients could afford a nurse/attendant, while 12.2% (n=5/41) had family members who quit their jobs to provide care. Major lower limb amputations significantly reduced overall patient functionality, including ambulation (p<0.001) and social functioning (p<0.001), with 20% (n=6/30) reporting a decline in physical, and 23% (n=7/30) in emotional aspects of their relationships. Income (p=0.477), mode of admission (p=0.335), and amputation level (p=0.477) did not significantly impact overall functionality post-surgery. Conclusions: Major lower limb amputations due to diabetic foot disease places significant financial and functional burdens on patients and their families in Pakistan.