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Most of them are preventable and reflect areas for improvement in health care, making it essential to know their epidemiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This is a retrospective population\u2010based cross\u2010sectional analysis on all lower limb amputations performed in public hospitals in Sao Paulo between 2009 and 2020, the most populous Brazilian state, with 46\u00a0million inhabitants. Using a public database, we evaluated types, rates and trends of the amputations performed, main etiologies leading to the indication for amputation, hospital length of stay and in\u2010hospital mortality rates, demographics of the amputees and procedure costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 180,595 lower limb amputations and surgical revision of amputations were performed, with toe amputations (45%) and major amputations (33%) being the most frequent types of surgeries, with a recent significant increase in the rates for both these procedures. Peripheral artery disease was the most frequent etiology, followed by diabetes mellitus, with both showing an upward trend over the years. Most patients were male (69.3%), Caucasians (55.6%) and elderly. August was the month with the highest number of amputations in all years. Overall in\u2010hospital mortality after lower limb amputations was 6.6%. Total reimbursed by the government was US$ 67,675,875.55.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Peripheral artery disease is the most frequent underlying diagnosis for lower limb amputations, followed by diabetes mellitus, with both showing an upward trend over the years. We observed seasonality in procedure rates, with peaks in August in all years.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06631-9","type":"journal-article","created":{"date-parts":[[2022,7,16]],"date-time":"2022-07-16T17:02:36Z","timestamp":1657990956000},"page":"2498-2506","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cross\u2010Sectional Analysis of 180,595\u00a0Lower Limb Amputations in the State of Sao Paulo Over 12 Years"],"prefix":"10.1002","volume":"46","author":[{"given":"Rodrigo Bruno","family":"Biagioni","sequence":"first","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo Rua Pedro de Toledo, 1800 04039\u2010000 Vila Clementino S\u00e3o Paulo \u2010 SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4133-3798","authenticated-orcid":false,"given":"Andressa Cristina Sposato","family":"Louzada","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Hospital Israelita Albert Einstein Av. 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