Upper limb amputations in Germany : a nationwide retrospective study of incidence, aetiologies and revision patterns from 2019 to 2023

Abstract

Objectives: To provide a nationwide epidemiological assessment of upper limb amputations (ULAs) in Germany, including incidence trends, underlying aetiologies, amputation levels and revision patterns, with a comparative analysis between 2019 and 2023. Design: Nationwide retrospective cross-sectional analysis of routinely collected inpatient hospital data. Setting: All acute-care hospitals in Germany reporting to the national Diagnosis-Related Groups and Operation and Procedure Classification System (OPS) from 2019 to 2023. Participants: All patients undergoing ULA procedures (OPS 5-862 and 5-863) or revision procedures (OPS 5-866) within the study period. No exclusion criteria were applied. Primary and secondary outcome measures: Primary measures were annual incidence of ULAs, the distribution of amputation levels and underlying medical aetiologies. Secondary measures included the incidence of revision procedures and revision aetiologies stratified by anatomical level. Result: A total of 5427 ULAs were performed in 2023, representing a 7.3% decrease compared with 2019 (5,852). Distal amputations remained most frequent, though proximal amputations increased proportionally over time. Above-wrist amputations were predominantly associated with malignancy (40.3%) and vascular disease (23.7%), whereas distal amputations were mainly trauma-related (43.6%). Infection-related distal amputations increased from 23.4% in 2019 to 30.4% in 2023. Revision procedures occurred in 32.4% of proximal amputations and 6.1% of distal amputations in 2023. Infection was the most common indication for distal revisions (53.3%), while infection and neuroma formation each accounted for 29.4% of proximal revisions. Conclusions: This nationwide analysis provides a comprehensive epidemiological overview of ULAs in Germany, demonstrating stable overall incidence but clear level-specific differences in underlying aetiologies. Proximal amputations were mainly associated with malignant and vascular disease, whereas trauma predominated at distal levels. High rates of infection-related and neuroma-related revisions, particularly after proximal amputations, highlight the complexity of surgical management and the need for level-specific perioperative and follow-up strategies.