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

Abstract

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.

1. Introduction

Amputation, defined as partial or complete surgical removal of a limb, represents a major yet largely preventable public health concern associated with profound long-term morbidity and socioeconomic consequences.^[1] It is a life-altering event with substantial physical, psychological, and economic burdens on both patients and healthcare systems.^[2] Despite advances in limb salvage surgical techniques, amputation remains prevalent worldwide.^[3] Each year, approximately 185,000 limb amputations are performed in the United States (US) alone, with over 2.3 million individuals currently living with limb loss. This number is projected to increase by 145%, reaching an estimated 5.7 million individuals living with a lost limb by 2060.^[4,5]

Amputations can be broadly classified as major (e.g., above- or below-knee) or minor (e.g., toe or finger) and can result from a wide range of causes, including diabetic foot complications, traumatic injuries, ischemic vascular diseases, and less common causes such as infections, deformities, and malignant tumors.^[6] The rising prevalence of noncommunicable diseases, particularly diabetes mellitus (DM) and peripheral artery disease (PAD), has become a major contributor to the high incidence of limb amputation in many regions.^[7,8] Notably, Saudi Arabia has the highest global rate of DM, with a current prevalence of 32.8% and a projected prevalence of 45.3% in 2030.^[9]

Complications related to diabetic foot ulcers (DFUs) represent a major risk factor for limb loss, with over 84% of patients eventually undergoing amputation.^[10,11] These patients typically require longer hospital stays and comprehensive rehabilitation programs.^[12] Moreover, they are more vulnerable to long-term disability, depression, and loss of productivity, all of which contribute substantially to the overall total cost.^[13]

The economic burden associated with amputation is high worldwide. In the US, the annual cost of lower-extremity amputations is estimated at $4.3 billion.^[14] Additionally, in the United Kingdom, managing DFUs and related amputations costs approximately £1.13 billion annually.^[15] Moreover, countries in the Middle East and North Africa region are also experiencing rising trends in amputation rates.^[11] In Qatar, the estimated direct cost of amputations, including hospitalization, is approximately $52 million.^[16] In addition to direct costs, amputations also lead to substantial indirect expenses, such as long-term disability, loss of productivity, and the need for ongoing rehabilitation and social support services.^[17]

In Saudi Arabia, extrapolating cost estimates from other jurisdictions is challenging because both the epidemiological profile and the structure of the healthcare system are likely to influence patterns of resource utilization associated with amputation care. The country has one of the highest global prevalences of DM, a primary driver of lower-extremity amputations, which may translate into higher surgical complexity, prolonged hospital stays, and increased utilization of inpatient services.^[18] In addition, healthcare delivery in Saudi Arabia is predominantly publicly funded, with most amputation care provided in government tertiary centers, potentially leading to cost structures that differ substantially from those reported in predominantly insurance-based or mixed healthcare systems.^[19,20]

These context-specific factors underscore the need for locally derived evidence on the direct surgical and hospitalization costs of limb amputation. Despite the growing burden of amputations, national data quantifying these costs remain limited, constraining efforts to inform prevention strategies, optimize service planning, and support value-based healthcare initiatives. Therefore, this study aimed to address this gap by presenting a comprehensive, decade-long retrospective analysis of the direct surgical and hospitalization costs associated with limb amputations at a high-volume tertiary care center in Saudi Arabia. Specifically, we aimed to estimate the direct surgical costs associated with amputations, analyze cost variation by patient characteristics, and evaluate the impact of length of hospital stay (LOS) on the total direct cost of care.

2. Materials and methods

2.1. Study design, setting, and population

This retrospective study was conducted at a tertiary care center in Riyadh, Saudi Arabia. The medical records of patients who underwent amputation between January 2015 and December 2024 were reviewed and analyzed. Both sexes in all age groups who underwent upper or lower limb amputations were eligible for inclusion, whereas patients with incomplete key medical record documentation were excluded during eligibility screening. Accordingly, no statistical imputation was performed, and analyses were based on available data from eligible records only. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and approved by the Institutional Review Board of the College of Medicine, King Saud University (Project No. E-24-2993). Given the retrospective nature of the study and the use of anonymized data, the Institutional Review Board committee waived the requirement for informed consent.

2.2. Data collection and variables

Data were extracted from the hospital’s electronic medical records and systematically recorded in a computerized database. Collected variables included demographic information (age, sex, and marital status), as well as amputation-related details such as etiology, amputation level, admission type (emergent vs elective), surgical specialty, and date of the procedure. Data regarding surgical and hospitalization costs were obtained from the hospital’s business center department. Surgical costs included operating room fees, surgeon and anesthetist charges, and surgical consumables. Procedure-level surgical costs were estimated using the department’s standardized tariff schedule for amputation procedures (Table 1). These unit procedure costs were applied consistently across the full study period (2015–2024) as fixed costs per procedure to maintain comparability of estimates across years; therefore, temporal differences in total and per-patient costs primarily reflect differences in volume, case-mix, and hospital length of stay rather than changes in unit procedure pricing. Hospitalization costs were recorded per day and included standard services, such as basic laboratory investigations, nursing care, and general ward expenses (Table 1). The total direct costs (surgical cost + hospitalization cost) were compared across demographic categories, etiology, amputation level, admission type, and year of surgery. The original cost data were recorded in Saudi Arabian Riyals and converted to United States dollars using a fixed exchange rate of 1 United States dollar = 3.75 Saudi Arabian Riyal for consistency and international comparison. For long-term scenario projection, a fixed 5% annual cost escalation rate was applied (compounded annually) to project total and per-patient costs from 2024 through 2050, using the observed 2024 values as the projection baseline. This rate was selected as a pragmatic modeling assumption to illustrate potential future economic burden under a constant-growth scenario rather than as an empirically derived Saudi amputation-specific inflation parameter.

Table 1.

Unit procedure and hospitalization costs applied in the analysis.

Procedure	Cost (SAR)	Cost (USD)
Toe amputation	2662	709
Metatarsal amputation	6988	1863
Lisfranc amputation	6988	1863
Syme amputation	6988	1863
Chopart amputation	6988	1863
Above-knee amputation	10,316	2750
Below-knee amputation	10,316	2750
Hip disarticulation	13,976	3726
Finger amputation	2662	709
Wrist amputation	5324	1419
Below-elbow amputation	6988	1863
Above-elbow amputation	6988	1863
Forequarter amputation	13,976	3726
Hospitalization cost per inpatient day	7622	2032

Costs shown are the fixed unit costs applied in the analysis across the study period.

SAR = Saudi Arabian Riyal, USD = United States dollar.

2.3. Statistical analysis

Descriptive statistics were used to summarize the patient demographics, clinical characteristics, and cost data. Continuous variables are presented as mean and standard deviation, while categorical variables are expressed as frequencies and percentages. Comparative cost analyses were conducted across subgroups (e.g., sex, age group, etiology, level of amputation, and year of surgery). Independent t tests and analysis of variance were used to assess the statistical significance of the cost differences between groups. The subgroup comparisons using t tests and analysis of variance were intended as unadjusted descriptive analyses and not as multivariable causal inference models. To project future costs, we applied a deterministic compound annual growth approach anchored to the observed 2024 values. Total direct costs and per-patient costs were projected from 2024 to 2050 using the formula $C_y=C_{2024}\times {(1+g)}^{(y-2024)}$, where $C_{2024}$ is the observed 2024 cost, $y$ is the projection year, and $g=0.05$ (5% annual cost escalation), compounded annually. Projections were reported as scenario estimates, and no uncertainty intervals were generated. Linear regression analysis was performed to assess relationships between continuous variables, including LOS and cost. Correlation coefficients were calculated to assess the relationships between continuous variables, such as the length of hospital stay and cost. Statistical significance was set at P < .05. All statistical analyses were conducted using IBM SPSS Statistics version 26.0 (IBM Corporation, Armonk).

3. Results

3.1. Demographic characteristics

Over the 10-year study period, 769 amputations were performed on 647 patients, with an estimated total direct cost of $32,390,307.75. This corresponds to an average cost of $50,062.30 per patient. Among the study population, 543 patients (84%) underwent a single amputation, whereas 104 patients (16%) required subsequent amputations and had a higher average per-patient cost ($66,661.92) compared to those who had a single amputation. The mean LOS was 23.78 days for single amputations and increased to 31.96 days for patients undergoing multiple amputations. The mean age of the population was 56.1 ± 21.1 years (range: 1–98 years). Age-specific trends revealed that patients aged 60 to 79 formed the largest group (41.9%) with a total cost of $14,785,144.90, and a per-patient cost of $54,557.73. The highest per-patient cost was observed in the 40 to 59 age group ($56,945.40), while the 0 to 19 group had the lowest at $13,360.78 (P < .05) (Table 2).

Table 2.

Demographic characteristics of patients undergoing amputations (2015–2024).

Demographics		Value	Percentage	Total cost	Per patient cost	P value
Total patient	N	647	–	$32,390,307.75	$50,062.30	–
Gender	Male	423	65.4%	$20,409,042.11	$48,248.33	<.05
	Female	224	34.6%	$11,981,265.64	$53,500.07
Marital status	Married	382	59.0%	$19,858,551.50	$51,985.74	<.05
	Single	256	39.6%	$12,276,508.75	$47,965.86
	Divorced	7	1.1%	$213,337.90	$30,476.84
	Widowed	2	0.3%	$41,909.60	$20,954.80
Age groups	0–19	58	9.0%	$772,174.55	$13,360.78	<.05
	20–39	50	7.7%	$2367,784.90	$47,355.70
	40–59	205	31.7%	$11,673,808.00	$56,945.40
	60–79	271	41.9%	$14,785,144.90	$54,557.73
	80 and older	63	9.7%	$2791,395.40	$44,307.86

Per-patient cost is the mean cost per patient.

Bold values indicate statistically significant results.

A notable sex disparity was observed, with 423 patients (65.4%) being male and 224 (34.6%) female. Despite the lower representation of females, the per-patient cost was higher for females ($53,500.07) compared to males ($48,248.33), a difference that was statistically significant (P < .05) (Table 2).

3.2. Etiology of amputation and associated costs

Diabetic complications were the leading cause of amputation, affecting 438 patients (67.7%) and accounting for the highest total cost of $24,040,331.78 (Table 3). Despite being the dominant cause, the per-patient cost for diabetic amputations stood at $54,886.60, indicating a high individual economic burden. Other causes included trauma (11.7%), vascular disease (11.6%), infection (4.0%), malignancy (2.3%), and deformities (2.6%). Notably, infections had the highest per-patient cost of $74,036.88, suggesting a prolonged LOS. Congenital deformities, in contrast, had the lowest per-patient cost ($7855.84). These differences were statistically significant (P < .05), highlighting the direct effect of etiology on resource utilization.

Table 3.

Overall and per patient costs across etiologies, site, admission type, and specialty.

Variables	Category	N	%	Total cost	Per-patient cost	P value
Etiology	Diabetic complications	438	67.7%	$24,040,331.78	$54,886.60	<.05
	Trauma	76	11.7%	$1,222,704.90	$16,088.22
	Malignancy	15	2.3%	$745,865.90	$49,724.39
	Vascular diseases	75	11.6%	$4,322,897.13	$57,638.63
	Infection	26	4.0%	$1,924,958.78	$74,036.88
	Deformities	17	2.6%	$133,549.27	$7855.84
Distribution of amputation site (lower limb)	Above knee amputation	128	19.8%	$7,940,921.40	$62,038.45	<.05
	Below knee amputation	160	24.7%	$9,270,998.50	$57,943.74
	Toe amputation	254	39.3%	$11,784,208.30	$46,394.52
	Metatarsal amputation	30	4.6%	$1,743,160.70	$58,105.36
	Lisfranc amputation	3	0.5%	$71,901.80	$23,967.27
	Syme amputation	2	0.3%	$65,549.80	$32,774.90
	Chopart amputation	5	0.8%	$270,074.40	$54,014.88
	Hip disarticulation	1	0.2%	$5759.50	$5759.50
Distribution of amputation site (upper limb)	Forequarter amputation	1	0.2%	$183,352.10	$183,352.10	<.05
	Above elbow amputation	8	1.2%	$246,955.45	$30,308.31
	Below elbow amputation	3	0.5%	$78,507.50	$26,169.17
	Wrist amputation	3	0.5%	$174,737.90	$58,245.97
	Finger amputation	49	7.6%	$554,180.40	$11,309.80
Type of admission	Emergency	466	72.0%	$24,673,630.42	$52,947.70	<.05
	Elective	181	28.0%	$7,716,677.33	$42,648.78

Per-patient cost is the mean cost per patient.

Bold values indicate statistically significant results.

3.3. Distribution of amputation site: lower versus upper limb

Lower-limb amputations accounted for the majority of cases, with a total cost of $31,152,574.40. Toe amputations (39.3%) and below-knee amputations (24.7%) were the most frequent, costing $11,784,208.30 and $9270,998.50, respectively. Above-knee amputations, although less frequent (19.8%), had the highest per-patient cost among lower limb amputations at $62,038.45. Partial foot amputations, such as metatarsal and Chopart amputations, also incurred relatively high per-patient costs ($58,105.36 and $54,014.88, respectively). These cost variations in the level of amputation were statistically significant (P < .05), reflecting the differences in surgical complexity and postoperative care needs.

Upper limb amputations were less common yet contributed to a total cost of $1,237,733.35. Finger amputations were the most frequent upper limb amputation, costing $11,309.80 per patient, whereas a forequarter amputation performed on a single patient had the highest individual cost of $183,352.10. The significant variation in costs (P < .05) suggests that upper limb amputations, especially major amputations, require specialized and costly interventions.

3.4. Admission type and surgical specialty

The majority of amputations (72%) were performed as emergency procedures, accounting for a total cost of $24,673,630.42 and an average per-patient cost of $52,947.70. In comparison, planned elective amputations comprised 28% of the cases, with a total cost of $7716,677.33 and a lower mean cost of $42,648.78 per patient. This cost disparity is statistically significant (P < .05), highlighting the increased financial burden associated with emergency interventions.

Vascular surgeons performed most of the amputations (n = 316, 48%), followed by orthopedic surgeons (n = 200, 30%). Plastic surgeons (12%) and general surgeons (8%) contributed to a smaller proportion of the cases.

3.5. Annual trends in amputations

Between 2015 and 2024, the total surgical cost for amputations demonstrated a significant annual variation. In 2015, the total cost was approximately $1.1 million, which steadily increased, peaking in 2018 at $4.47 million. A slight decline followed in subsequent years, with 2024 recording $3.27 million in total costs. The per-patient surgical cost also varied across the decade, reaching a maximum of $72,117.90 in 2018. Conversely, the lowest per-patient cost was noted in 2021 at $36,882.00.

3.6. Projections of future costs

Under the fixed 5% annual growth scenario, the total direct costs of amputation are projected to increase by 34% by 2030, from $3.27 million in 2024 to $4.38 million. This is expected to further increase to $7.14 million by 2040 (118% increase) and reach $11.62 million by 2050 (255% increase). Additionally, per-patient costs are projected to increase from $37,576 in 2024 to $133,610 by 2050. These scenario-based estimates highlight the potential long-term economic burden of amputation and reinforce the need for targeted prevention strategies and policy reforms (Fig. 1).

Figure 1.

Scenario-based projection of mean direct cost per patient from 2024 to 2050 under a fixed 5% annual compounded growth assumption. Costs are presented in US dollars (USD).

3.7. Regression analysis

Regression analysis demonstrated a strong positive correlation between the duration of hospital stay and total cost per patient (R = 0.9999, R² = 0.9998), indicating that over 99.9% of the variance in cost can be attributed to the number of inpatient days. This relationship was statistically significant (P < .0001). The model estimated that each additional hospital day would increase the total cost by approximately $2036. The regression model demonstrated an excellent fit with a very low standard error and high F-statistic, confirming the predictive strength of hospital stay duration on total patient cost.

4. Discussion

This retrospective study evaluated the association of demographic characteristics, underlying etiologies, and anatomical distribution with the direct surgical and hospitalization costs of limb amputations over 10 years in Saudi Arabia. Globally, studies assessing the economic burden of amputation remain limited. To the best of our knowledge, this is the first study to be conducted in Saudi Arabia. Our study revealed that the total direct cost of 769 amputations was $32,390,307.75, with an average of $50,062.30 per patient.

In our cohort, female patients had higher mean per-patient costs than male patients, and the highest per-patient costs were observed in the 40 to 59-year age group. These findings should be interpreted cautiously as the subgroup comparisons were unadjusted and the study was not designed to determine independent predictors of cost, the observed differences may reflect variation in case-mix, amputation level, urgency of admission, perioperative complexity, discharge needs, and comorbidity burden rather than direct effects of sex, age, or marital status. Existing literature suggests that demographic characteristics may be associated with differences in amputation pathway and inpatient resource utilization. Lefebvre et al,^[18] who noted that women are more likely to undergo major amputations, which is associated with longer hospital stays and higher overall costs. The mean age of our population was 52 years, with the highest per-patient costs observed in the 40 to 59 age group. This aligns with the findings of McDermott et al^[19] and Tong et al,^[20] who reported that younger and middle-aged adults with DFUs tend to have higher risks of amputations and longer hospital stays than older adults in similar clinical settings. These differences are likely multifactorial and may reflect underlying variation in disease severity, amputation level, perioperative complexity, and discharge needs rather than sociodemographic status alone. Prior inpatient cost analyses have shown that patient factors (including sex and age) are associated with length of stay and total hospital costs following lower-extremity amputation, with older age consistently linked to greater resource utilization.^[21] In addition, sex-specific disparities in PAD and chronic limb-threatening ischemia may contribute; women with PAD are frequently older at presentation and may experience delayed recognition and treatment, which can increase the likelihood of urgent admission and major amputation pathways that carry higher inpatient resource needs.^[22,23] Since a higher amputation level is an important driver of hospital utilization (e.g., above-knee procedures associated with longer hospitalization than below-knee procedures in contemporary series), any subgroup skewed toward more proximal amputations would be expected to accrue higher costs.^[24] With respect to marital status, the literature has often treated marital status as a proxy for social support, with some cohorts reporting higher costs/longer stays among those who are not married.^[21] In our setting, the opposite pattern may reflect case-mix confounding, as unmarried patients are more likely to be younger and to undergo lower-cost trauma-related amputations compared with the dysvascular/diabetes-related amputations that dominate older, predominantly married groups. Future multivariable modeling adjusting for age, etiology, amputation level, admission type, and comorbidity burden would help clarify whether sex and marital status remain independently associated with cost.

Diabetic complications were the leading cause, accounting for 67.7% of amputations, costing $24 million in total, with an average of $54,886 per patient. These findings are consistent with Walicka et al,^[25] who reported a similar prevalence of 68.7%, and those of Petrakis et al,^[26] who reported an average per-patient cost of approximately $45,000. In contrast, a study conducted in the US estimated the average cost per patient for diabetic lower extremity amputation at $17,103, which may be attributed to a lower proportion of major amputations in their population, likely due to earlier detection and timely intervention, which often limits the need for major amputations, thus reducing the overall cost.^[27] Notably, patients requiring amputation due to infections had the highest per-patient costs, reflecting a longer hospital stay. In contrast, congenital deformities were associated with significantly lower expenditure, indicating less acute or resource-intensive utilization.

In this study, lower limb amputations were far more common, particularly toe and below-knee amputations, costing $11.8 million and $9.3 million, respectively. This distal-to-proximal progression reflects the typical course of diabetic foot disease and is consistent with findings reported in the literature.^[28,29] Interestingly, upper limb amputations, which comprised only 10% of the cases, were disproportionately expensive. For instance, a single forequarter amputation costs $183,000, demonstrating the high resource intensity and longer hospital stay of such advanced procedures.

The average LOS in our population was 23.78 days for patients who underwent a single amputation, increasing to 31.96 days for those who underwent multiple amputations. This difference reflects the increased complexity and extended postoperative care associated with repeated amputation. These findings are consistent with those of Weuster et al, who reported an average hospital stay of 38 days and longer durations in patients requiring multiple surgical revisions.^[30]

Emergency amputations accounted for 72% of all cases, and these cases incurred significantly higher per-patient costs ($52,947.70) compared to planned, elective procedures ($42,648.78). This is explained by the fact that emergency amputations have a higher complication rate, require longer hospital stays, and have worse rehabilitation outcomes, which contribute to the overall higher total and per-patient costs.^[31] This finding highlights the urgent need for preventive measures to reduce the incidence of emergency procedures.

Our analysis showed a nearly linear correlation between length of stay and total cost, suggesting that cost-saving strategies must prioritize early discharge, outpatient wound care, and telemedicine. Additionally, earlier diabetes screening, better glycemic control programs, and integrated diabetic foot care services for high-risk diabetic patients could play a transformative role in detecting complications early and reducing the incidence of amputation.

This study emphasizes the urgent need for system-level reforms to reduce the growing burden of limb amputation in Saudi Arabia. First, expanding multidisciplinary diabetic foot teams, comprising endocrinologists, surgeons, podiatrists, and rehabilitation experts, has been shown globally and locally to reduce emergency procedures and length of stay. Armstrong et al^[32] showed that integrating multidisciplinary diabetic foot teams significantly reduced the number of urgent amputations from 77.7% to 48.5%. Furthermore, they also found a 45.7% decrease in the incidence of major limb amputations in integrated diabetic foot teams. Second, the creation of a national amputation registry is essential for benchmarking trends and enabling targeted policy response. Addressing demographic disparities, such as higher per-patient costs among women and middle-aged adults, requires focused outreach and early intervention strategies. Future efforts should prioritize models that shorten postoperative hospitalization via telehealth and home-based care. Additionally, integrating long-term costs, including prosthetics and lost productivity, into economic evaluations offers a more comprehensive view of strategic planning.

The strength of this study lies in its large sample size and extended timeframe, which enhances the reliability of the cost estimations and allows for various subgroup analyses based on different patient characteristics. Additionally, this is the first study with a comprehensive, decade-long analysis of the direct economic burden of extremity amputation in Saudi Arabia. However, this study has several limitations that must be acknowledged. First, single-center data may affect the generalizability of the findings to other healthcare settings, although our institution is one of the largest tertiary care centers in Saudi Arabia and receives referrals across the country, which enhances the representativeness of the sample. Second, potential sources of bias included the retrospective nature of record abstraction, exclusion of incomplete records, and the single-center tertiary-care setting, which may have introduced information bias, selection bias, and limited generalizability. Third, surgical procedure costs were estimated using the hospital business center’s standardized tariff schedule and applied consistently across the study period; while this approach supports internal comparability across years, it does not capture potential temporal changes in unit pricing (e.g., inflationary adjustments), and therefore cost trends should be interpreted primarily as reflecting changes in utilization, case-mix, and length of stay. Fourth, the long-term projections to 2050 were based on a fixed 5% annual escalation assumption and should therefore be interpreted as illustrative scenario estimates rather than precise forecasts, as the model was not calibrated using an empirically derived Saudi amputation-specific cost inflation parameter. Finally, the cost estimates were limited to direct in-hospital surgical and hospitalization costs captured in the institutional records and did not include outpatient care, rehabilitation, prosthetics, readmissions, or indirect costs such as productivity loss; therefore, the reported estimates likely underestimate the full economic burden of amputation. Despite these limitations, this study lays critical groundwork for future cost-effectiveness studies and provides valuable insights for healthcare policymakers in allocating resources and developing preventive strategies to reduce the incidence of amputation.

In conclusion, this decade-long study highlights the economic burden of limb amputations in Saudi Arabia, which is driven by patient demographics, amputation level, and etiology. Middle-aged patients, especially those with diabetic complications, were major contributors to the overall high cost. Prolonged hospital stays further inflate expenses. These findings highlight the urgent need for preventive strategies to improve the care of diabetic foot. Investing in early intervention and limb preservation programs can reduce avoidable amputation and overall costs. This study offers critical insights for healthcare policymakers to support efficient and equitable resource allocation and health system strengthening.

Author contributions

Conceptualization: Abdulrahman Alaseem, Mishari Alanezi.

Data curation: Mohammad Aljarba.

Formal analysis: Mishari Alanezi, Mohammed Alhuqbani.

Investigation: Abdulrahman Alaseem, Ibrahim S Alshaygy.

Methodology: Mishari Alanezi, Mohammed Alhuqbani.

Software: Mohammad Aljarba.

Visualization: Ibrahim S Alshaygy, Waleed Albishi.

Writing – original draft: Abdulrahman Alaseem.

Writing – review & editing: Ibrahim S Alshaygy, Waleed Albishi.

Correction

A new academic degree “MSc” has been added for Author “Waleed Albishi.“ The online version has now been updated from “Waleed Albishi, MBBS, FRCSC” to “Waleed Albishi, MBBS, MSc, FRCSC.”