Comparison of General vs. Spinal Anesthesia in Diabetic Foot Patients undergoing MLLA in LMIC - A post propensity score matching

Objectives: Diabetic foot ulcers frequently require Major Lower Limb Amputation (MLLA) which is a high-risk procedure particularly in Lower-Middle-Income Countries (LMICs). While regional anesthesia is theorized to offer better hemodynamic stability generally, there is a lack of conclusive evidence comparing Spinal Anesthesia (SA) and General Anesthesia (GA) specifically in infected diabetic foot population who have different hemodynamic profile due to longstanding diabetes generally. Methodology: This retrospective cohort study evaluated perioperative outcomes in one hundred diabetic patients undergoing MLLA at a tertiary care center in Pakistan between 2018 and 2022. A 1:3 Propensity Score Matching (PSM) was utilized to address inherent bias related to retrospective data. The result of matching was the final cohort of 58 patients (20 SA and 38 GA). Results: The primary outcome demonstrated a significantly shorter median hospital length of stay (LOS) in the SA group (4.0 days; IQR 3.0-4.5) compared to the GA group (7.0 days; IQR 5.0-11.0) (p=0.001). Secondary outcomes, including short-term follow-up, local wound complications (infection, necrosis), and ICU admissions, showed no statistically significant differences between the two anesthetic modalities due to low count. Conclusions: Spinal anesthesia is associated with a significantly reduced hospital stay in diabetic patients undergoing MLLA compared to general anesthesia, without increasing perioperative morbidity or mortality.