Lower extremity amputations in Switzerland: Trends in patients with and without diabetes, 2013–2023

Abstract

Background and aims Lower extremity amputation (LEA) is a critical public health issue predominantly caused by diabetes mellitus (DM) and peripheral arterial disease (PAD). Switzerland faces a growing diabetes burden amid suboptimal glycemic control. The aim was to analyze LEA trends in Switzerland (2013-2023), comparing diabetic and non-diabetic populations to inform targeted prevention and management strategies. Methods A retrospective, nationwide analysis of Swiss hospital discharge data from 2013 to 2023 was conducted. LEA cases were identified via Swiss surgical procedure codes and stratified by diabetes status using ICD-10-GM diagnosis codes. Age-standardized incidence rates and amputation proportions were computed, with Poisson regression models to evaluate risk factors. Outcomes including in-hospital mortality and re-amputation rates were assessed. From 2013 to 2023, 30,047 lower extremity amputations were performed in Switzerland, with 60% occurring in patients with diabetes and 85% being minor amputations. Crude annual numbers increased, but age-standardized rates remained stable. Patients with diabetes had a 56% higher adjusted risk than those without. Amputation proportions in diabetes-related hospitalizations decreased over time, driven by a reduction in minor amputations, while major amputations remained stable. In-hospital mortality was 4.3%, lowest in type 1 diabetes, and 13% experienced re-amputation within 36 months. Conclusions Lower-extremity amputation remains a preventable complication; improved diabetes control and access to early, multidisciplinary foot care are critical to further reduce avoidable limb loss in Switzerland.