{"id":"https://openalex.org/W7222948486","doi":"https://doi.org/10.3390/healthcare14203518","title":"Etiology and Anatomical Level of Lower-Limb Amputations in Two Iranian Referral Hospitals: A Retrospective Record-Based Study","display_name":"Etiology and Anatomical Level of Lower-Limb Amputations in Two Iranian Referral Hospitals: A Retrospective Record-Based Study","publication_year":2026,"publication_date":"2026-10-19","ids":{"openalex":"https://openalex.org/W7222948486","doi":"https://doi.org/10.3390/healthcare14203518","pmid":"https://pubmed.ncbi.nlm.nih.gov/42940562","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13704086"},"language":"en","primary_location":{"id":"doi:10.3390/healthcare14203518","doi":"https://doi.org/10.3390/healthcare14203518","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14203518","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/healthcare14203518","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5041839978","display_name":"Hossein Akbari Aghdam","orcid":"https://orcid.org/0000-0001-6983-4458","observed_orcids":["https://orcid.org/0000-0001-6983-4458"]},"institutions":[{"id":"https://openalex.org/I114982161","display_name":"Isfahan University of Medical Sciences","ror":"https://ror.org/04waqzz56","country_code":"IR","type":"education","lineage":["https://openalex.org/I114982161"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Hossein Akbari Aghdam","raw_affiliation_strings":["Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran"],"raw_orcid":"https://orcid.org/0000-0001-6983-4458","affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran","institution_ids":["https://openalex.org/I114982161"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028658353","display_name":"Mehdi Motififard","orcid":"https://orcid.org/0000-0003-2597-3063","observed_orcids":["https://orcid.org/0000-0003-2597-3063"]},"institutions":[{"id":"https://openalex.org/I114982161","display_name":"Isfahan University of Medical Sciences","ror":"https://ror.org/04waqzz56","country_code":"IR","type":"education","lineage":["https://openalex.org/I114982161"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Mehdi Motififard","raw_affiliation_strings":["Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran","institution_ids":["https://openalex.org/I114982161"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159046574","display_name":"Hasan Yazdekhasti","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I114982161","display_name":"Isfahan University of Medical Sciences","ror":"https://ror.org/04waqzz56","country_code":"IR","type":"education","lineage":["https://openalex.org/I114982161"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Hasan Yazdekhasti","raw_affiliation_strings":["Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran","institution_ids":["https://openalex.org/I114982161"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5103070880","display_name":"Fouad Rahimi","orcid":"https://orcid.org/0000-0002-2031-1418","observed_orcids":["https://orcid.org/0000-0002-2031-1418"]},"institutions":[{"id":"https://openalex.org/I3122832768","display_name":"Kurdistan University of Medical Sciences","ror":"https://ror.org/01ntx4j68","country_code":"IR","type":"education","lineage":["https://openalex.org/I3122832768"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Fouad Rahimi","raw_affiliation_strings":["Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 66177-13446, Iran"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 66177-13446, Iran","institution_ids":["https://openalex.org/I3122832768"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159088208","display_name":"Mahsa Jamali","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I70640408","display_name":"Tehran University of Medical Sciences","ror":"https://ror.org/01c4pz451","country_code":"IR","type":"education","lineage":["https://openalex.org/I70640408"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Mahsa Jamali","raw_affiliation_strings":["Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran 14197-33141, Iran"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran 14197-33141, Iran","institution_ids":["https://openalex.org/I70640408"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5026664225","display_name":"Mohammad Shahsavan","orcid":"https://orcid.org/0000-0003-4402-4103","observed_orcids":["https://orcid.org/0000-0003-4402-4103"]},"institutions":[{"id":"https://openalex.org/I114982161","display_name":"Isfahan University of Medical Sciences","ror":"https://ror.org/04waqzz56","country_code":"IR","type":"education","lineage":["https://openalex.org/I114982161"]}],"countries":["IR"],"is_corresponding":true,"raw_author_name":"Mohammad Shahsavan","raw_affiliation_strings":["Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran"],"raw_orcid":"https://orcid.org/0000-0003-4402-4103","affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran","institution_ids":["https://openalex.org/I114982161"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5026664225"],"corresponding_institution_ids":["https://openalex.org/I114982161"],"apc_list":{"value":2700,"currency":"CHF","value_usd":3258},"apc_paid":{"value":2700,"currency":"CHF","value_usd":3258},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.80207919,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"20","first_page":"3518","last_page":"3518"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11227","display_name":"Diabetic Foot Ulcer Assessment and Management","score":0.9282000064849854,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11227","display_name":"Diabetic Foot Ulcer Assessment and Management","score":0.9282000064849854,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10926","display_name":"Peripheral Artery Disease Management","score":0.0494999997317791,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13986","display_name":"Medical Practices and Rehabilitation","score":0.004000000189989805,"subfield":{"id":"https://openalex.org/subfields/3612","display_name":"Physical Therapy, Sports Therapy and Rehabilitation"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/lower-extremity-amputation","display_name":"lower limb amputation","score":1.0},{"id":"https://openalex.org/keywords/amputation-etiology","display_name":"amputation etiology","score":0.9789999723434448},{"id":"https://openalex.org/keywords/amputation-level","display_name":"amputation level","score":0.9580000042915344},{"id":"https://openalex.org/keywords/traumatic-amputation","display_name":"traumatic amputation","score":0.8029999732971191},{"id":"https://openalex.org/keywords/infection","display_name":"infection","score":0.5720000267028809},{"id":"https://openalex.org/keywords/toe-amputation","display_name":"toe amputation","score":0.8009999990463257},{"id":"https://openalex.org/keywords/transtibial-amputation","display_name":"transtibial amputation","score":0.9789999723434448},{"id":"https://openalex.org/keywords/age-differences","display_name":"age differences","score":0.531000018119812},{"id":"https://openalex.org/keywords/interhospital-variation","display_name":"interhospital variation","score":0.7570000290870667},{"id":"https://openalex.org/keywords/case-mix","display_name":"case mix","score":0.859000027179718},{"id":"https://openalex.org/keywords/iranian-hospitals","display_name":"Iranian hospitals","score":0.6830000281333923}],"concepts":[{"id":"https://openalex.org/C137627325","wikidata":"https://www.wikidata.org/wiki/Q156318","display_name":"Etiology","level":2,"score":0.9352999925613403},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8673999905586243},{"id":"https://openalex.org/C2776204877","wikidata":"https://www.wikidata.org/wiki/Q477415","display_name":"Amputation","level":2,"score":0.8579999804496765},{"id":"https://openalex.org/C2776135927","wikidata":"https://www.wikidata.org/wiki/Q5242559","display_name":"Referral","level":2,"score":0.7113000154495239},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.5056999921798706},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.4302999973297119},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.41110000014305115},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.34769999980926514},{"id":"https://openalex.org/C45827449","wikidata":"https://www.wikidata.org/wiki/Q5270338","display_name":"Diagnosis code","level":3,"score":0.3005000054836273},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.29159998893737793},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.2897000014781952},{"id":"https://openalex.org/C2983685735","wikidata":"https://www.wikidata.org/wiki/Q5227355","display_name":"Data source","level":2,"score":0.2863999903202057},{"id":"https://openalex.org/C519991488","wikidata":"https://www.wikidata.org/wiki/Q28865","display_name":"Python (programming language)","level":2,"score":0.28119999170303345},{"id":"https://openalex.org/C3018822202","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Patient data","level":2,"score":0.2809999883174896},{"id":"https://openalex.org/C2780283434","wikidata":"https://www.wikidata.org/wiki/Q7705274","display_name":"Tertiary referral hospital","level":3,"score":0.26739999651908875},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.2635999917984009},{"id":"https://openalex.org/C524204448","wikidata":"https://www.wikidata.org/wiki/Q788926","display_name":"Infectious disease (medical specialty)","level":3,"score":0.25189998745918274},{"id":"https://openalex.org/C2778818304","wikidata":"https://www.wikidata.org/wiki/Q1819478","display_name":"Rehabilitation","level":2,"score":0.2513999938964844}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.3390/healthcare14203518","doi":"https://doi.org/10.3390/healthcare14203518","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14203518","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13704086","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13704086/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13704086/pdf/healthcare-14-03518.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare (Basel)","raw_type":"Text"},{"id":"pmid:42940562","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42940562","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare (Basel, Switzerland)","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.3390/healthcare14203518","doi":"https://doi.org/10.3390/healthcare14203518","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14203518","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[{"id":"https://openalex.org/F4320322245","display_name":"Isfahan University of Medical Sciences","ror":"https://ror.org/04waqzz56"}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7222948486.pdf","grobid_xml":"https://content.openalex.org/works/W7222948486.grobid-xml"},"referenced_works_count":21,"referenced_works":["https://openalex.org/W1866803133","https://openalex.org/W1995232516","https://openalex.org/W2163278718","https://openalex.org/W2844153221","https://openalex.org/W3093792124","https://openalex.org/W3127257791","https://openalex.org/W3182486863","https://openalex.org/W4205387650","https://openalex.org/W4205951840","https://openalex.org/W4211197206","https://openalex.org/W4283589371","https://openalex.org/W4292229870","https://openalex.org/W4319072768","https://openalex.org/W4376959696","https://openalex.org/W4387820339","https://openalex.org/W4391354283","https://openalex.org/W4402180187","https://openalex.org/W4408382079","https://openalex.org/W4411090715","https://openalex.org/W4412625873","https://openalex.org/W4414212741"],"related_works":["https://openalex.org/W7045909727","https://openalex.org/W2244104016","https://openalex.org/W2331650374","https://openalex.org/W2153181596","https://openalex.org/W2161275809","https://openalex.org/W1995232516","https://openalex.org/W4225880972","https://openalex.org/W4317433817","https://openalex.org/W3003764212","https://openalex.org/W2947314326"],"abstract_inverted_index":{"Background:":[0],"Lower-limb":[1],"amputation":[2,35,54,171],"arises":[3],"from":[4,8,63,75,102],"heterogeneous":[5],"pathways":[6],"ranging":[7],"severe":[9],"trauma":[10],"to":[11,26,37,93],"dysvascular":[12,124,229],"disease":[13,125],"and":[14,30,36,57,92,113,127,157,170,183,193,220,230,251],"infection,":[15],"yet":[16],"comparative":[17],"data":[18],"across":[19,133],"Iranian":[20],"hospitals":[21,59],"remain":[22],"limited.":[23],"We":[24],"aimed":[25],"characterize":[27,94],"demographic,":[28],"etiologic,":[29],"anatomical":[31],"patterns":[32],"of":[33],"lower-limb":[34,53],"evaluate":[38],"between-hospital":[39,239],"heterogeneity.":[40],"Methods:":[41],"This":[42],"retrospective,":[43],"two-hospital,":[44],"record-based":[45],"study":[46],"included":[47],"229":[48],"eligible":[49],"hospitalization":[50],"records":[51],"with":[52,148,167,200],"at":[55,152,195,225],"Al-Zahra":[56,196],"Kashani":[58],"in":[60,235],"Isfahan,":[61],"Iran,":[62],"13":[64],"April":[65],"2014":[66],"through":[67],"18":[68],"March":[69],"2020.":[70],"Primary":[71],"etiology":[72,120,169],"was":[73,100,117,165,206],"reconstructed":[74],"ordered":[76],"diagnostic":[77],"codes":[78,85],"using":[79],"a":[80],"predefined":[81],"hierarchical":[82],"algorithm;":[83],"external-cause":[84],"were":[86,161,198],"reviewed":[87],"as":[88,256],"supporting":[89],"contextual":[90],"information":[91],"documented":[95],"traumatic":[96],"mechanisms.":[97],"Amputation":[98],"level":[99,172],"derived":[101],"ICD-9-CM":[103],"procedure":[104],"codes.":[105],"Analyses":[106],"used":[107],"Python":[108],"3.13.5":[109],"(NumPy,":[110],"pandas,":[111],"SciPy,":[112],"statsmodels).":[114],"Results:":[115],"Trauma":[116],"the":[118],"leading":[119],"(49.3%),":[121],"followed":[122],"by":[123,217],"(28.8%)":[126],"infection":[128],"(10.5%).":[129],"Age":[130],"differed":[131],"strongly":[132],"etiologies":[134],"(H":[135],"=":[136,143,181],"93.71;":[137],"Holm-adjusted":[138,174],"p":[139,175],"<":[140,176],"0.001;":[141,177],"epsilon-squared":[142],"0.398,":[144],"95%":[145],"CI":[146],"0.307\u20130.509),":[147],"trauma-related":[149],"hospitalizations":[150,212,223,232],"occurring":[151],"younger":[153,226],"ages.":[154],"Toe":[155],"(35.4%)":[156],"below-knee":[158],"(34.5%)":[159],"amputations":[160],"most":[162],"frequent.":[163],"Hospital":[164,197],"associated":[166,199],"both":[168],"(both":[173],"bias-corrected":[178],"Cramer\u2019s":[179],"V":[180],"0.374":[182],"0.471,":[184],"respectively).":[185],"In":[186],"an":[187],"adjusted":[188],"major-versus-minor":[189],"model,":[190],"older":[191],"age":[192],"treatment":[194],"major":[201],"amputation,":[202],"whereas":[203,228],"female":[204],"sex":[205],"not":[207,253],"statistically":[208],"significant.":[209],"Conclusions:":[210],"The":[211,237],"showed":[213],"marked":[214],"descriptive":[215],"differences":[216,240],"age,":[218],"etiology,":[219],"hospital.":[221],"Trauma-related":[222],"occurred":[224,233],"ages,":[227],"infection-related":[231],"later":[234],"life.":[236],"substantial":[238],"indicate":[241],"that":[242],"pooled":[243],"hospital-based":[244],"estimates":[245],"may":[246],"obscure":[247],"institutional":[248],"case":[249],"mix":[250],"should":[252],"be":[254],"interpreted":[255],"population-level":[257],"incidence.":[258]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-10-20T00:00:00"}