Clinical and economic burden of major lower-limb amputations attributable to peripheral artery disease in Italy: A nationwide analysis
5 affiliations
- 1Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy.
- 2Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
- 3Vascular Surgery Unit, IRCCS Sant'Orsola, Azienda Ospedaliero-Universitaria, Bologna, Italy.
- 4Interventional Radiology Unit, Foot & Ankle Clinic Policlinico Abano Terme, Abano Terme, Italy.
- 5UOC Diabetes and Endocrinology, CTO Hospital, Department of Surgical Science, University of Rome "Tor Vergata", Rome, Italy.
Abstract
Peripheral artery disease (PAD) represents a major cause of non-traumatic lower-limb amputation and is associated with substantial morbidity, mortality, and healthcare costs. Despite advances in medical and revascularization therapies, major amputations remain frequent, and comprehensive nationwide estimates of their clinical and hospital-related economic burden within the Italian National Health Service (SSN) are limited. The objectives of this study were to estimate the hospital-related economic burden of major lower-limb amputations attributable to PAD in Italy and to assess revascularization patterns and in-hospital mortality within the SSN. We conducted a nationwide observational study using the Italian National Hospital Discharge Database. Acute hospital discharges between 2015 and 2021 with a major lower-limb amputation and Diagnosis Related Group 113 were identified. Inpatient volumes, length of stay, and costs were estimated by amputation level. A longitudinal cohort of patients amputated between 2015 and 2017 was followed for two years before and after the index hospitalization to assess prior revascularization and in-hospital mortality using age- and sex-adjusted Cox models. A total of 26,417 PAD-attributable major amputations were identified, 75.6% of which were above-knee procedures. Cumulative inpatient expenditure reached €294 million, corresponding to over 511,000 hospital days. Only 46.0% of patients underwent revascularization before amputation. In-hospital mortality increased steeply within the first six months post-amputation and remained higher after above-knee procedures and among patients with diabetes, reaching 16–25% at 180 days and 23–34% at two years. Major lower-limb amputation remains a severe and costly outcome of PAD in Italy. Improved implementation of guideline-recommended PAD management is needed to reduce avoidable amputations and their economic burden on the SSN.
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BibTeX
@article{scortichini2026clinical,
title = {{Clinical and economic burden of major lower-limb amputations attributable to peripheral artery disease in Italy: A nationwide analysis}},
author = {Matteo Scortichini and Mauro Gargiulo and Marco Manzi and Luigi Uccioli and Paolo Sciattella},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0361853},
url = {https://doi.org/10.1371/journal.pone.0361853},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical and economic burden of major lower-limb amputations attributable to peripheral artery disease in Italy: A nationwide analysis
AU - Matteo Scortichini
AU - Mauro Gargiulo
AU - Marco Manzi
AU - Luigi Uccioli
AU - Paolo Sciattella
PY - 2026
DA - 2026/11/02
JO - PLOS One
DO - 10.1371/journal.pone.0361853
UR - https://doi.org/10.1371/journal.pone.0361853
AB - Peripheral artery disease (PAD) represents a major cause of non-traumatic lower-limb amputation and is associated with substantial morbidity, mortality, and healthcare costs. Despite advances in medical and revascularization therapies, major amputations remain frequent, and comprehensive nationwide estimates of their clinical and hospital-related economic burden within the Italian National Health Service (SSN) are limited. The objectives of this study were to estimate the hospital-related economic burden of major lower-limb amputations attributable to PAD in Italy and to assess revascularization patterns and in-hospital mortality within the SSN. We conducted a nationwide observational study using the Italian National Hospital Discharge Database. Acute hospital discharges between 2015 and 2021 with a major lower-limb amputation and Diagnosis Related Group 113 were identified. Inpatient volumes, length of stay, and costs were estimated by amputation level. A longitudinal cohort of patients amputated between 2015 and 2017 was followed for two years before and after the index hospitalization to assess prior revascularization and in-hospital mortality using age- and sex-adjusted Cox models. A total of 26,417 PAD-attributable major amputations were identified, 75.6% of which were above-knee procedures. Cumulative inpatient expenditure reached €294 million, corresponding to over 511,000 hospital days. Only 46.0% of patients underwent revascularization before amputation. In-hospital mortality increased steeply within the first six months post-amputation and remained higher after above-knee procedures and among patients with diabetes, reaching 16–25% at 180 days and 23–34% at two years. Major lower-limb amputation remains a severe and costly outcome of PAD in Italy. Improved implementation of guideline-recommended PAD management is needed to reduce avoidable amputations and their economic burden on the SSN.
SN - 1932-6203
ER -