Diabetic foot ulcer is a major health care problem leading to hospitalization, morbidity, amputation and mortality in diabetic patients. The aim of this study is to determine the amputation-free probability and prognostic factors of major amputation among hospitalized diabetic foot patients in a tertiary teaching hospital in Malaysia. A retrospective record review study was conducted among 231 hospitalized diabetic foot patients in Hospital Universiti Sains Malaysia from 1st January 2007 until 31st December 2011 followed by 1 year follow up. Patients’ medical records were retrieved and reviewed. Socio-demographic, clinical characteristics and amputation endpoint status were recorded. The duration of amputation-free time was measured from the date of being diagnosed as diabetic foot until the date of amputation.Simple and Multiple Cox regression were performed to determine the prognostic factors of major amputation. The patients’ age ranged from 21 to 83, with mean (SD) was 56.9 (10.4) years. Majority were male (51.5%) and Malays (95.7%). The overall proportion of amputation due to diabetic foot was 88.7% which comprised of minor (76.6%) and major amputation (13.7%). The adjusted prognostic factors that were found to be significantly influence the risk of having major amputation among hospitalized diabetic foot patients in HUSM were age at diagnosed of DFU (Adjusted HR: 1.05, 95% CI: 1.00, 1.09, P=0.033), gender (Adjusted HR: 0.21, 95% CI: 0.07,0.66, P=0.007), duration of DM (Adjusted HR: 2.76, 95% CI: 1.25, 6.12, P=0.012), smoking status(Adjusted HR: 4.19, 95% CI: 1.12, 15.65, P=0.033) and status of DFU (Adjusted HR: 2.55, 95% CI: 1.10, 6.07, P=0.029). Older diabetic patients, female, having diabetes more than 10 years, smoker and recurrent DFU were at higher risk of major amputation.