Occupational risk factors for major lower extremity amputation： A retrospective cohort study from a single center

Lower-limb amputation (LLA) is associated with a significantly declined quality of life and high mortality rates, highlighting the importance of early intervention. Occupational and environmental factors may contribute to delayed healing of foot ulcers in patients with chronic limb-threatening ischemia (CLTI) or diabetic foot ulcers (DFU). However, few studies have investigated the association between occupation and LLA. In this study, we aimed to elucidate the relationship between occupation and LLA and identify occupational risk factors for the development of preventive and interventional strategies.

We conducted a retrospective analysis of 83 patients (mean age; 71 ± 12.6 years) who underwent major LLA for leg ulcers at our hospital between January 2019 and June 2024. Data on the longest-held occupation, ankle-brachial index (ABI), and clinical outcomes were collected and analyzed.

Among the 96 amputated limbs, 71 were below-knee amputations (BKA), 22 were above-knee amputations (AKA), and one was hip disarticulation. The mortality rate was 27 % at 1 year and 40 % at 3 years post-amputation. Occupational classification revealed that 24 (44 %) patients had standing occupations, 27 (49 %) had sedentary occupations, and 16 (18 %) were unemployed. No significant occupational differences were observed in the incidence of arteriosclerosis obliterans. No significant differences were observed between occupational groups regarding the presence of osteomyelitis or ABI values.

This study focused on the occupational background of patients who underwent LLA, particularly on the relative risks of standing and sedentary occupations. Large-scale epidemiological research is warranted to refine occupation-specific risk assessments, improve workplace conditions, and develop preventive strategies.