Major lower-limb amputation remains a severe and costly outcome of PAD in Italy, with 26,417 PAD-attributable major amputations (2015-2021) costing €294 million in inpatient expenditure, and improved implementation of guideline-recommended PAD management is needed to reduce avoidable amputations and their economic burden on the SSN.
The study identified 26,417 PAD-attributable major lower-limb amputations in Italian acute hospitals between 2015 and 2021, most of them above-knee.
Cumulative inpatient expenditure for PAD-attributable major amputations reached €294 million over the study period, with more than 511,000 hospital days.
Fewer than half of patients underwent revascularization before their major amputation.
In-hospital mortality rose steeply in the first six months after amputation and was higher after above-knee amputation and among patients with diabetes.
The authors conclude that major amputation is a severe and costly PAD outcome in Italy and that better implementation of guideline-recommended PAD management is needed.
This study looked at national hospital records in Italy from 2015 to 2021 to measure how often people with peripheral artery disease (PAD, narrowed arteries in the legs) ended up having a major leg amputation, what it cost the hospital system, and how patients fared afterward. It found 26,417 such amputations, about three-quarters of them above the knee. Hospital costs came to about €294 million, with over 511,000 days spent in hospital. Only 46% of these patients had undergone a procedure to restore blood flow (revascularization) before their amputation. After amputation, death in hospital rose quickly over the first six months. By 180 days, 16-25% had died, and by two years, 23-34% had died. Deaths were more common after above-knee amputations and among people with diabetes. This research suggests that many amputations from PAD in Italy may be avoidable if guideline-recommended care is applied more consistently, which could also reduce costs. The study used hospital discharge data only, so it captures hospital costs and in-hospital outcomes rather than the full picture of care.
Scortichini M, Gargiulo M, Manzi M, Uccioli L, Sciattella P. (2026). Clinical and economic burden of major lower-limb amputations attributable to peripheral artery disease in Italy: A nationwide analysis.. PloS one. https://doi.org/10.1371/journal.pone.0361853