Abstract Background Lower extremity amputations (LEAs) are common among people with diabetes, resulting in high disability and mortality. Understanding trends in diabetes-related LEAs is important for assessing the quality of care. Aim of this study was to evaluate predictors and time trends in LEAs in a region of Southern Italy, focusing on gender difference. Methods Hospital discharge records were used to identify all diabetic adult patients hospitalized for LEAs between 2006 and 2015. For each year, gender- and age-adjusted standardized hospitalization rates for major and minor amputations were calculated and time trends were analyzed by gender. Predictors of LEAs were estimated by a multivariable regression model. Results In the study period, 579 major and 1345 minor amputations were performed in Abruzzo. Gender- and age-adjusted standardized admission rates decreased for minor amputations among both males (-29.96%) and females (-5.33%), whereas major amputations rates decreased only for males (-44.73%). Males were at higher risk of undergoing major (Rate Ratio [RR] 1.41, 95%CI 1.19-1.67) and minor (RR 1.62, 95%CI 1.45-1.82) amputations, but the male-to-female rate ratio decreased for major and minor amputations. Peripheral vascular disease was the main predictor of major (adjOR 4.09, 95%CI 3.31-5.06) and minor amputations (adjOR 12.90, 95%CI 11.00-15.12). Age over 85 (adjOR 9.07, 95%CI 1.84-44.71) and more than 3 comorbidities (adjOR 2.51, 95%CI 1.75-3.60) were parameters associated only with major amputations. Conclusions Reducing the number of LEAs represents a healthcare priority. This study emphasizes the existence of gender disparities in LEAs, highlighting a significant reduction of LEAs for males and a lack of improvement for females. Thus, it is worthwhile to investigate potential clinical, behavioral and healthcare-related causes of this difference, in order to plan health system changes aimed at improving care and facilitating access to health care for women. Key messages Time trends in LEAs showed a substantial improvement only for males, highlighting the existence of gender difference. Understanding the underlying causes is essential to improve the quality of care.

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