In the world of diabetic foot care, we often find ourselves at a crossroads when a patient presents with isolated toe necrosis. Traditionally, this meant an automatic ticket to the operating room (OR) for a conventional amputation surgery (CAS). But as operating rooms become increasingly crowded and resources stretched thin, we have to ask: is it actually safe to perform these procedures at the bedside?
Recent data suggests that not only is it safe, but it might be the more efficient path forward for many patients.
Bedside vs. Operating Room: The Evidence
A multi-center study recently compared Bedside Amputation Surgery (BAS)—performed right in the diabetes unit by specialized clinicians—to conventional surgery in the OR. The goal was to determine if moving the procedure out of the sterile OR environment compromised patient safety or healing.
The results were promising:
- Equivalent Healing: At the 6-month mark, the healing rate for bedside procedures was 53.8%, virtually identical to the 52.3% seen in the OR group.
- No Increase in Re-operation: There was no statistically significant difference in the need for follow-up surgeries between the two groups (24.5% for BAS vs. 16.9% for CAS).
- A Viable Alternative: The study concluded that BAS is a safe and efficient alternative for managing isolated necrosis in diabetes units.
Why Shift the Setting?
For years, the “gold standard” has been the sterile environment of the OR. However, “perfect” shouldn’t be the enemy of “good” (and fast).
- Eliminating Delays: Moving to the bedside bypasses the logistical hurdles and wait times associated with OR scheduling.
- Streamlined Care: Patients can stay within their specialized diabetes unit, reducing the stress of transport and keeping them in the care of their primary diabetic foot team.
- Resource Management: Utilizing the bedside for simpler, isolated cases frees up OR time for more complex vascular or orthopedic reconstructions.
Identifying the Ideal Candidate
While BAS is a powerful tool, success relies on proper patient selection. The data indicates that outcomes are less predictable in patients with:
- Severe Ischemia: Specifically, those with fewer than two patent leg vessels.
- High Inflammatory Markers: Success rates were lower in patients presenting with high CRP levels or extensive local infection.
The Bottom Line
We are entering an era where the diabetologist and the surgeon can share the “blade” more effectively. By performing bedside amputations for delimited toe necrosis, we can provide high-quality care in approximately two-thirds of cases, reserving the OR for the most complex scenarios.
It is time to stop thinking of the OR as the only theater for surgery and start seeing the bedside as a safe, effective site for limb-saving intervention — in the right patient at the right time.
Manuscript: Feron, et al, Bedside amputation surgery for isolated toe necrosis in diabetes units as an alternative to conventional amputation in surgery units, Diabetes and Metabolism, 2026
DOI: https://doi.org/10.1016/j.diabet.2026.101531
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