Citation: Rusu, E.; Coman, H.; Cos , oreanu, A.; Militaru, A.-M.; Popescu-Vâlceanu, H.-C.; Teodoru, I.; Mihai, D.-A.; Elian, V.; Gavan, N.A.; Radulian, G. Incidence of Lower Extremity Amputation in Romania: A Nationwide 5-Year Cohort Study, 2015–2019. Medicina 2023, 59, 1199. https://doi.org/10.3390/ medicina59071199 Academic Editor: Åke Sjöholm Received: 18 May 2023 Revised: 15 June 2023 Accepted: 24 June 2023 Published: 25 June 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). medicina Article Incidence of Lower Extremity Amputation in Romania: A Nationwide 5-Year Cohort Study, 2015–2019 Emilia Rusu 1 , Horat , iu Coman 2 , Andrada Cos , oreanu 1, *, Ana-Maria Militaru 3 , Horat , iu-Cristian Popescu-Vâlceanu 4 , Ileana Teodoru 5 , Doina-Andrada Mihai 5 , Viviana Elian 5 , Norina Alinta Gavan 6 and Gabriela Radulian 5 1 Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, Malaxa Clinical Hospital, 030167 Bucharest, Romania; emilia.rusu@umfcd.ro 2 Department of Vascular Surgery, Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania; horatiucoman@gmail.com 3 Department of Diabetes, Nutrition and Metabolic Diseases, Malaxa Clinical Hospital, 02441 Bucharest, Romania; ana-maria.militaru@rez.umfcd.ro 4 Department of Diabetes, Nutrition and Metabolic Diseases, 915400 Oltenita, Romania; horatiucristian.ph@gmail.com 5 Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, “Prof. Dr. Nicolae Paulescu” National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania; ileana.teodoru@umfcd.ro (I.T.); andrada.mihai@umfcd.ro (D.-A.M.); viviana.elian@umfcd.ro (V.E.); gabriela.radulian@umfcd.ro (G.R.) 6 Wörwag Pharma Romania SRL, 400267 Cluj-Napoca, Romania; norina.gavan@woerwagpharma.ro * Correspondence: andrada.cosoreanu@rez.umfcd.ro Abstract: Background and Objectives: The primary objective of this study was to investigate the incidence of lower extremity amputations (LEAs) in a representative population from Romania, in both diabetic and non-diabetic adults, including trauma-related amputations. The secondary objective was to evaluate the trends in LEAs and the overall ratio of major-to-minor amputations. Material and Methods: The study was retrospective and included data from the Romanian National Hospital Discharge Records, conducted between 1 January 2015 and 31 December 2019. Results: The overall number of cases with LEAs was 88,102, out of which 38,590 were aterosclerosis-related LEAs, 40,499 were diabetes-related LEAs, and 9013 were trauma-related LEAs, with an ascending trend observed annually for each of these categories. Of the total non-traumatic amputations, 51.2% were in patients with diabetes. Most LEAs were in men. The total incidence increased from 80.61/100,000 in 2015 to 98.15/100,000 in 2019. Conclusions: Our study reported a 21% increase in total LEAs, 22.01% in non-traumatic LEAs, and 19.65% in trauma-related amputation. The minor-to-major amputation ratio increased over the study period in patients with diabetes. According to these findings, it is estimated that currently, in Romania, there is one diabetes-related amputation every hour and one non-traumatic amputation every 30 min. Keywords: lower extremity amputations (LEAs); atherosclerosis-related LEAs; diabetes-related LEAs; traumatic LEAs 1. Introduction Lower limb amputations represent a challenging condition for patients and the health- care system, causing complex social, professional, educational, and family integration drawbacks by reducing the quality of life and increasing the economic burden. The two major causes of lower-extremity amputations (LEA) both in low-income and in economically developed countries are diabetes and chronic vascular disease, affecting, predominately, patients between 55 and 75 years old [1]. LEAs are between 15 and 40 times more prevalent in people with diabetes [2]. Medicina 2023, 59, 1199. https://doi.org/10.3390/medicina59071199 https://www.mdpi.com/journal/medicina