Leg amputations and arterial reconstructions in Romanian hospitals

What each hospital reported in 2025#

Every discharge from a Romanian hospital goes into a diagnosis-related group (RO-DRG v1.1), and the National Institute for Health Services Management publishes, hospital by hospital, how many stays each group had. This page uses five groups, counted in hospital stays, not in people.

Amputation of the foot, lower leg or thigh (F1111 and F1112): 5,170 stays in 2025, more than 14 a day. The grouping rule puts a stay with both a bypass and an amputation into the bypass group, so these are stays without a major reconstruction in the same admission.

Major arterial reconstruction (F1081 and F1082): 5,336 stays. The group covers bypass on the leg arteries, but also grafts on the aorta and the pelvic arteries. A count in this group therefore does not mean legs saved; a zero means the hospital reported no stay in these two groups.

Other arterial procedures (F1141–F1143): 45,118 stays: balloon angioplasty or stenting, removal of a clot, surgery on the carotid artery. Creating dialysis fistulas is not in it. There are also amputations of fingers and hand (4,744 stays, F1130) and diabetic foot surgery (2,257 stays, K1010), a group that also includes some amputations in people with diabetes.

1,948 of the 5,170 stays with an amputation (38 per cent) took place in 150 hospitals that reported no major arterial reconstruction in 2025. Another 1,187 took place in hospitals with fewer than 50: in all, 61 per cent of amputations.

The 17 counties with no major arterial reconstruction in 2025#

All hospitals of each county in the national tables are added up: state, military and private. Where the total of major arterial reconstructions is zero, the county is in the table. In 7 of the 17 counties the total was zero in each of the eight years from 2018 to 2025, among the hospitals that filed in that year: Botoșani, Gorj, Caraș-Severin, Mehedinți, Vrancea, Teleorman, Giurgiu.

In these counties there were, in 2025, 1,100 stays with an amputation of the foot, lower leg or thigh, 1,048 with an amputation of a finger or the hand, and 709 for the diabetic foot. Ilfov has zero reconstructions but is 19 minutes from Bucharest.

How far the nearest arterial reconstruction centre is#

The calculation starts from the 19 state or military hospitals that reported at least 50 major arterial reconstructions and at least 20 stays with an amputation in 2025. The second condition leaves out three hospitals with at least 50 reconstructions but fewer than 20 amputations: the heart institutes in Iași and Cluj and the military hospital in Sibiu. The reconstruction group also includes operations on the aorta. For every commune and town, the drive to the nearest one is calculated without traffic. Of 19.1 million residents, 8.4 million (44 per cent) are more than an hour from such a hospital, 3.9 million (21 per cent) more than an hour and a half, and 1.2 million more than two hours.

Nine private hospitals with at least 50 reconstructions together reported 1,911. All are in Bucharest, Timișoara, Iași or Sibiu, in the same city as a state centre, so they change the drive little; other private clinics report fewer reconstructions, and cost and access are outside this page.

The centres: the 19 state or military hospitals with at least 50 major arterial reconstructions and 20 amputations in 2025

The test the hypothesis failed: in counties without reconstruction, hospitals reported fewer amputation stays per resident#

The hypothesis was written down before any calculation: in counties without reconstruction, stays with an amputation per 100,000 residents would be at least 35 per cent higher than in counties with at least 50 reconstructions. The result is the opposite. The median is 20.2 in the 16 counties without reconstruction, against 29.4 in the 15 with at least 50 reconstructions (ratio 0.69, p = 0.008). The same calculation on appendicectomies, an operation that does not depend on vascular surgery, gives medians of 20.9 and 24.5 (p = 0.62): the difference runs the same way and is not significant, so part of the gap may come from where people are treated in general.

A hospital counts the stays in it, not the residents of its county. Someone who lives in a county without reconstruction and is operated in Iași, Cluj or Bucharest appears in that city’s statistics. The data do not hold the patient’s county of residence, so they cannot show whether families in counties without reconstruction are amputated more or less often. The page does not claim that missing reconstruction raises a county’s number of amputations; it shows where reconstructions are done and how far away they are.

From 2018 to 2025: more reconstructions, almost the same amputations#

In the 197 hospitals that filed reports in every year, stays with a major arterial reconstruction rose from 2,103 to 2,966, by 41 per cent, and those with other arterial procedures from 11,682 to 22,166. Stays with an amputation of the foot, lower leg or thigh stayed almost level (4,376, then 4,295), and diabetic foot surgery fell from 2,407 to 1,721. These are stays, not people; the data do not show how many patients needed revascularisation or arrived too late.

Three county hospitals show the pattern over time. In Râmnicu Vâlcea, reconstructions fell from 59 in 2018 to zero in 2025, while amputations stayed between 60 and 88 a year. Călărași had 50 in 2021, then zero in every year from 2022, with 62 to 89 amputations a year. In Botoșani the county hospital reported no reconstruction in any of the eight years, and between 79 and 114 amputations a year.

What these numbers do not say#

A stay is not a person: someone with an amputation of a toe, then of the foot, appears twice. A zero means zero reported in groups F1081 and F1082, not proof that an operation is done nowhere else or under another code.

A hospital with many reconstructions may receive the hard cases from other counties, so the ratio of amputations to reconstructions is not a quality ranking. Nor are all amputations avoidable: in a patient with wet gangrene and infection, amputation can be the operation that saves life.

At hospital level, 39 of the 81 that reported at least 30 amputations of any kind reported no reconstruction, but for 19 of them another hospital in the same county did. That is why the page counts counties, not hospitals.

The drive is an estimate without traffic, from the centre of each settlement to the hospital, on the OpenStreetMap network. The model was tuned on 8,670 OSRM routes of 3–75 minutes (mean error three minutes on that set). On 24 routes over 75 minutes, compared with the public OSRM server, the model’s estimate was, in the median, 2 per cent lower than the OSRM server’s, with a mean absolute difference of 7 per cent and a largest difference of 40 per cent lower; no drives were timed. The exact position of some hospitals is approximated by the town centre; the map marks them with a ring.

If an amputation is proposed: what the guidelines say#

This is not advice for any particular case, and the page has not been reviewed by a vascular surgeon. The international guidelines say the following.

The international guideline on chronic limb-threatening ischaemia (Global Vascular Guidelines, 2019) asks that a non-urgent amputation be discussed in a team after a full vascular and functional assessment. Primary amputation may be appropriate, after specialist assessment and a shared decision with the patient, when the artery can no longer be reconstructed, when the foot can no longer bear weight, when infection threatens life, or when life expectancy is very short.

The guideline on arterial disease in people with diabetes and a foot ulcer (IWGDF/ESVS/SVS, 2023) asks for urgent consultation with a vascular surgeon if the ischaemia is severe or the ulcer is infected or gangrenous, and says there should be a centre that offers both endovascular treatment and bypass, or at least quick access to one.

A leg that suddenly turns cold, pale or loses feeling or movement is a medical emergency: the European guideline on acute limb ischaemia (ESVS, 2020) asks for immediate assessment by a vascular surgeon.

For symptoms that start suddenly or a severe infection, call 112 or go to an emergency department at once. Do not delay treatment or a transfer the doctors recommend in order to look for another hospital. The team discussion and full vascular assessment apply to amputations that are not urgent.

All 212 hospitals with amputations of the foot, lower leg or thigh in 2025#