Etiology and Anatomical Level of Lower-Limb Amputations in Two Iranian Referral Hospitals: A Retrospective Record-Based Study.
- 1Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran.
- 2Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 66177-13446, Iran.
- 3Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran 14197-33141, Iran.
Abstract
Background: Lower-limb amputation arises from heterogeneous pathways ranging from severe trauma to dysvascular disease and infection, yet comparative data across Iranian hospitals remain limited. We aimed to characterize demographic, etiologic, and anatomical patterns of lower-limb amputation and to evaluate between-hospital heterogeneity. Methods: This retrospective, two-hospital, record-based study included 229 eligible hospitalization records with lower-limb amputation at Al-Zahra and Kashani hospitals in Isfahan, Iran, from 13 April 2014 through 18 March 2020. Primary etiology was reconstructed from ordered diagnostic codes using a predefined hierarchical algorithm; external-cause codes were reviewed as supporting contextual information and to characterize documented traumatic mechanisms. Amputation level was derived from ICD-9-CM procedure codes. Analyses used Python 3.13.5 (NumPy, pandas, SciPy, and statsmodels). Results: Trauma was the leading etiology (49.3%), followed by dysvascular disease (28.8%) and infection (10.5%). Age differed strongly across etiologies (H = 93.71; Holm-adjusted p < 0.001; epsilon-squared = 0.398, 95% CI 0.307-0.509), with trauma-related hospitalizations occurring at younger ages. Toe (35.4%) and below-knee (34.5%) amputations were most frequent. Hospital was associated with both etiology and amputation level (both Holm-adjusted p < 0.001; bias-corrected Cramer's V = 0.374 and 0.471, respectively). In an adjusted major-versus-minor model, older age and treatment at Al-Zahra Hospital were associated with major amputation, whereas female sex was not statistically significant. Conclusions: The hospitalizations showed marked descriptive differences by age, etiology, and hospital. Trauma-related hospitalizations occurred at younger ages, whereas dysvascular and infection-related hospitalizations occurred later in life. The substantial between-hospital differences indicate that pooled hospital-based estimates may obscure institutional case mix and should not be interpreted as population-level incidence.
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BibTeX
@article{aghdam2026etiology,
title = {{Etiology and Anatomical Level of Lower-Limb Amputations in Two Iranian Referral Hospitals: A Retrospective Record-Based Study.}},
author = {Hossein Akbari Aghdam and Mehdi Motififard and Hasan Yazdekhasti and Fouad Rahimi and Mahsa Jamali and Mohammad Shahsavan},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14203518},
url = {https://europepmc.org/article/MED/42940562},
note = {CC BY},
}
RIS
TY - JOUR
TI - Etiology and Anatomical Level of Lower-Limb Amputations in Two Iranian Referral Hospitals: A Retrospective Record-Based Study.
AU - Hossein Akbari Aghdam
AU - Mehdi Motififard
AU - Hasan Yazdekhasti
AU - Fouad Rahimi
AU - Mahsa Jamali
AU - Mohammad Shahsavan
PY - 2026
DA - 2026/10/19
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14203518
UR - https://europepmc.org/article/MED/42940562
AB - Background: Lower-limb amputation arises from heterogeneous pathways ranging from severe trauma to dysvascular disease and infection, yet comparative data across Iranian hospitals remain limited. We aimed to characterize demographic, etiologic, and anatomical patterns of lower-limb amputation and to evaluate between-hospital heterogeneity. Methods: This retrospective, two-hospital, record-based study included 229 eligible hospitalization records with lower-limb amputation at Al-Zahra and Kashani hospitals in Isfahan, Iran, from 13 April 2014 through 18 March 2020. Primary etiology was reconstructed from ordered diagnostic codes using a predefined hierarchical algorithm; external-cause codes were reviewed as supporting contextual information and to characterize documented traumatic mechanisms. Amputation level was derived from ICD-9-CM procedure codes. Analyses used Python 3.13.5 (NumPy, pandas, SciPy, and statsmodels). Results: Trauma was the leading etiology (49.3%), followed by dysvascular disease (28.8%) and infection (10.5%). Age differed strongly across etiologies (H = 93.71; Holm-adjusted p < 0.001; epsilon-squared = 0.398, 95% CI 0.307-0.509), with trauma-related hospitalizations occurring at younger ages. Toe (35.4%) and below-knee (34.5%) amputations were most frequent. Hospital was associated with both etiology and amputation level (both Holm-adjusted p < 0.001; bias-corrected Cramer's V = 0.374 and 0.471, respectively). In an adjusted major-versus-minor model, older age and treatment at Al-Zahra Hospital were associated with major amputation, whereas female sex was not statistically significant. Conclusions: The hospitalizations showed marked descriptive differences by age, etiology, and hospital. Trauma-related hospitalizations occurred at younger ages, whereas dysvascular and infection-related hospitalizations occurred later in life. The substantial between-hospital differences indicate that pooled hospital-based estimates may obscure institutional case mix and should not be interpreted as population-level incidence.
SN - 2227-9032
ER -