Non-Traumatic Lower-Limb Amputations: Outcome, Sex-Differences, Comorbidity Patterns and Temporal Trends from 2006 to 2022

<b>Background/Objectives:</b> Non-traumatic lower-limb amputations are associated with high mortality and a dramatic loss of quality of life. Peripheral artery disease and diabetes are the most common causes of non-traumatic lower-limb amputations. The aim of the study was to assess temporal trends in mortality, comorbidities and sex differences in patients with non-traumatic lower-limb amputations. <b>Methods</b>: A total of 1107 patients who underwent lower-limb amputation for non-traumatic causes at the Medical University of Innsbruck between 2006 and 2022 were reviewed and analyzed. Temporal trends in mortality, sex-differences in outcomes and the comorbidity spectrum were assessed. <b>Results</b>: In hospitals, 30-day and 1-year mortality has remained high from 2006 to 2022 (4.14%; 16.2%; 23.2%) with chronic kidney disease, heart failure and major amputations as predictors of 1-year mortality. Diabetes, peripheral artery disease and cerebrovascular disease were the most common causes of death in females, and liver disease, renal disease and myocardial infarction in males, respectively. Overall comorbidity frequency was high, with there being even increasing rates of coronary heart disease, atrial fibrillation and chronic pulmonary disease during the study period. Age at first amputation was significantly higher in women than in men (78.9 vs. 68.1 years). Median age increased and median LDL-cholesterol decreased in males but not in females during the time period. Major amputations were performed more frequently in females than in males as the first surgical intervention. <b>Conclusions</b>: Mortality and morbidity are high in patients with non-traumatic limb amputation. Our data underline the need of intensified risk-factor management with lower limb amputation, especially in females.