The study
A systematic review and meta-analysis published in BJS Open on 23 October 2026 by authors from Birmingham, Cardiff and Stellenbosch.
It pooled population-level studies of major lower limb amputation published between 2008 and 2025: 52 studies covering 1,067,616 patients. Study quality was assessed with the Newcastle–Ottawa scale.
Reading the numbers
The 95% confidence interval (CI) is the range the true average plausibly sits in. The prediction interval is wider: it's the range a new hospital or health system could plausibly see. When studies disagree a lot, the prediction interval tells you more about what to expect in any one setting than the average does.
What they found
30-day mortality, all major amputations: 9.4% (95% CI 8.0 to 11.0), prediction interval 4.0% to 20.4%, from 390,030 patients.
30-day mortality, transtibial: 5.5% (4.5 to 6.7), prediction interval 2.5% to 11.6%.
30-day mortality, transfemoral: 10.9% (8.3 to 14.2), prediction interval 4% to 26.6%.
In-hospital mortality, all major amputations: 10.0% (8.2 to 12.1), prediction interval 3.6% to 24.5%. In-hospital deaths weren't capped at 30 days, so this includes some later deaths.
Heterogeneity, the disagreement between studies, was above 75% in every analysis. Mortality was the only outcome pooled, so the review gives no combined figures for re-amputation or readmission.
Where the data came from
Twenty-two studies came from North America and 19 from Europe and Central Asia. Five came from East Asia and the Pacific, including two from New Zealand, and only three from low- and middle-income countries. None came from Australia.
The New Zealand studies are the closest comparison: 9.7% 30-day mortality overall in one, and 11.1% after diabetes-related amputation in the other.
Some of the "population-level" data come from US surgical registries such as NSQIP and VQI, which only include hospitals that take part.
What it means for your practice
About one in ten people died within 30 days of a major amputation. The figure was roughly double after above-knee amputation (10.9%) compared with below-knee (5.5%). The review doesn't adjust for how unwell each group was beforehand.
The range between health systems was wide. A 30-day mortality anywhere from 4% to 20% would be consistent with these data, so the 9.4% average says little about any particular hospital.
These are population averages. A patient's own risk depends on their vascular disease, kidney function, infection, frailty and the reason for amputation, none of which this review adjusts for.
There's no Australian figure. The New Zealand studies sit close to the pooled average, which is the nearest guide we have.
Bottom line
Across 52 studies, 9.4% of people died within 30 days of a major lower limb amputation: 5.5% after transtibial and 10.9% after transfemoral. Results varied widely between settings, and none of the data is Australian.