Publication Details
Abstract
Background: Limb loss in Iraq reflects two realities that often meet in the same clinics: a growing burden of chronic disease (particularly diabetes and peripheral arterial disease) and serious injuries related to road traffic events and explosive remnants of war. Yet, rehabilitation outcomes from private-sector settings in Baghdad are rarely described. Objective: To describe the clinical causes and levels of limb amputation and to examine rehabilitation outcomes among Iraqi patients receiving post-amputation care in private hospitals in Baghdad. Methods: We performed a cross-sectional study in three private hospitals in Baghdad (January–October 2025). Adults (≥18 years) with a major or minor upper- or lower-limb amputation in the previous 24 months were recruited consecutively from orthopaedic, vascular, and rehabilitation clinics. We combined patient interviews with medical-record review to document demographics, comorbidities, cause and level of amputation, time to rehabilitation, prosthesis access and use, physiotherapy exposure, common complications (residual limb pain, phantom pain, skin problems), and functional outcomes. Mobility was assessed using the Amputee Mobility Predictor with prosthesis (AMPPro) when applicable. We used descriptive statistics and multivariable logistic regression to identify factors associated with a favourable functional outcome (AMPPro ≥26 or independent community ambulation). Results: Among 220 participants (mean age 52.8 years; 71.4% men), diabetes-related foot complications (44.1%) and trauma (30.0%) were the leading causes of amputation. Most amputations were lower limb (82.7%), and the commonest major levels were transtibial (34.5%) and transfemoral (21.8%). Patients typically entered structured rehabilitation several weeks after surgery (median 7 weeks; IQR 4–14). The first fitting of a prosthetic leg for 58.7% of eligible lower-limb amputees occurred at an average of 5.5 months (IQR 3 - 9) after obtaining a prosthesis; 46.8% were determined by evaluation to have improved functionality at the final follow-up. The adjusted results indicate that younger patients, those with transtibial level amputation, early initiation of rehabilitation, use of a prosthesis, and controlled di- abetes were associated with better functional outcome outcomes. Conclusions: The findings suggest that the predominant reason for amputations due to diabetes is the result of the amputated limb; therefore, there are also many more amputations associated with diabetes than due to trauma. Additionally, the delay between surgery and rehabilitation and prosthetic fitting varies from patient to patient. Therefore, improvements should be made in diabetic foot prevention programs and creating coordinated pathways for referrals of patients to rehabilitation services and prosthetic services for more timely rehabilitation to improve functional recovery.