Cor Vasa 2026, 68(5):569-573 | DOI: 10.33678/cor.2025.119

Differences in Outcomes Between Major Amputation and Wound Debridement on Inflammatory Response and Length of Stay in Type 2 Diabetic Foot Ulcer Patients Treated at Airlangga University Hospital: A Retrospective Study

Aloysius Denzel Joshua Reviano^a, Danang Himawan Limanto^b, Hermawan Susanto^c, Satriyo Dwi Suryantoro^c

^a Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

^b Department of Thoracic Cardiovascular Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

^c Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: According to the International Diabetes Federation (IDF) in 2021, Indonesia had a diabetes mel litus (DM) prevalence of 10.8% out of the total population, approximately 19.4 million individuals. The most common complication, diabetic foot ulcer (DFU), has a 15-34% risk of developing in diabetic patients and a 40-60% recurrence rate. The early stage of DFU requires wound debridement, but as pain and immobility worsen, the need for amputation ultimately rises. The importance of this study is to compare preoperative and postoperative level of leukocyte, neutrophil-lymphocyte ratio (NLR), and length of stay (LOS) between wound debridement and major amputation, as well to evaluate wound debridement's healing factor on DFU to avoid amputation.

Methods: This is an observational cohort retrospective study. A total sampling method was used to retrieve medical records from Airlangga University Hospital, Surabaya, with the study period of January-June 2024. The population was adult patients above 18 years old and diagnosed with type 2 DM with DFU in Wagner scale of 0-5 that had received wound debridement or major amputation. The research variables were preoperative leukocyte, postoperative leukocytes, leukocyte difference, preoperative NLR, postoperative NLR, preoperative LOS, postoperative LOS, and total LOS. We compared those variables between two groups, which are wound debridement and major amputation. Data were analyzed using SPSS 27 and Microsoft Excel version 16.102.2.

Results: We found that there is a significant difference between the two groups in terms of preoperative leukocyte and leukocyte difference (p <0.05), while other variables were found not significant (p >0.05). Wound debridement groups had lower preoperative leukocytes and a smaller leukocyte decrease compared to those undergoing major amputation. This represents lower inflammation response in patients receiving wound debridement compared to major amputation. Although postoperative leukocytes aren't significant, the leukocyte difference between preoperative and postoperative was significant. This marks a greater re duction in leukocytes following major amputation, reflecting inflammation suppression.

Conclusion: Wound debridement has lower preoperative leukocyte and leukocyte difference. Further stu dies on other variables are recommended to describe inflammatory processes in patients with DFU.

Keywords: Diabetic foot ulcer, Major amputation, Type 2 diabetes mellitus, Wound debridement

Received: November 6, 2025; Revised: November 10, 2025; Accepted: November 16, 2025; Prepublished online: October 12, 2026; Published: October 20, 2026  Show citation