Economic burden of extremities amputations: A 10-year retrospective analysis of direct surgical and hospitalization costs

Limb amputation is a major public health concern, with profound physical, psychological, and socioeconomic consequences. Although largely preventable, the prevalence of amputation continues to rise, particularly in regions with high rates of diabetes and vascular diseases. Despite this, national-level data evaluating demographic trends, clinical characteristics, and the associated costs of amputations remain limited. This study aimed to provide a comprehensive decade-long retrospective analysis to assess the epidemiological patterns and economic burden of amputations. A retrospective review was conducted of all limb amputations performed at a tertiary care center in Saudi Arabia from 2015 to 2024. Patient demographics, etiology, amputation level, surgical specialty, and admission type were extracted. Surgical costs were analyzed in terms of total expenditure and per-patient costs using hospital financial records. Statistical analyses included descriptive statistics and comparative cost assessments across the subgroups. Regression analysis was used to assess the relationship between length of hospital stay and cost. A total of 769 amputations were performed on 647 patients, resulting in a total direct cost of $32.39 million and an average cost of $50,062.30 per patient. Diabetic complications were the leading cause (67.7%), associated with a total cost of $24 million and an average per-patient cost of $54,886.60. Emergency amputations (72%) incurred significantly higher per-patient costs than elective procedures ($52,947.70 vs $42,648.78, P < .05). Lower-limb amputations were more common, and among lower-limb procedures, above-knee amputations had the highest per-patient cost ($62,038.45 per patient). This study highlights the substantial financial burden of limb amputation in Saudi Arabia, with diabetic complications being the predominant cause. The findings highlight the urgent need for enhanced preventive strategies, particularly diabetic foot care and early intervention programs, to reduce the incidence and economic burden of amputation.