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VOLUME 7, ISSUE 2 

 2024 
 

RESEARCH ARTICLE 

 

Johannesson A, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 

Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

https://jps.library.utoronto.ca/index.php/cpoj/index
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https://doi.org/10.33137/cpoj.v7i2.44089


 

1 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

 

 

RESEARCH ARTICLE 

 

EVALUATION OF THE SWEDEAMP DATABASE: FOCUS ON COVERAGE AND AMPUTATION 

LEVEL RATES 

Johannesson A.G1 *, Scheving R2, Westlund k.L2, Fridriksson T2  

1. Össur Clinics EMEA, Stockholm, Sweden. 
2. Össur Iceland Ehf., R&D, Medical Office, Reykjavik, Iceland. 
  
 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

National patient registers collect data on diseases and 

treatments within specialized care, covering all inpatient 

admissions and outpatient doctor visits in these setting.  

 

 

 

 

 

 

A register can be used to monitor long-term health trends in 

the population, improve the prevention and treatment of 

diseases, contribute to the development of health care, and 

monitor the quality of health care services.1 In lower limb 

amputation (LLA), this can be the only practical option to 

evaluate the selection of amputation level due to ethical 

considerations, cost, and practicality. In developed 

countries, elderly and often frail populations are the main 

subject to amputation due to vascular disease and are rarely 

included in scientific studies that can evaluate different 

treatment options.2 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: The National Board of Health and Welfare manages several national registers 

in Sweden. This includes the Swedish National Inpatient Register (IPR), covering all surgical 

operations, and SwedeAmp, focusing on outcomes after lower limb amputations (LLA). 

However, coverage rates of amputation levels between these registers have not been externally 

analyzed. 

OBJECTIVE: To compare SwedeAmp's coverage with IPR for LLA cases and to assess 

SwedeAmp's accuracy in capturing LLA data. The goal of this study was also to identify potential 

discrepancies and establish benchmarks for common amputation levels. 

METHODOLOGY: Data from both registers, covering the years 2018 to 2023, were compared 

regarding the amputation levels and patient demographics. The coverage rate of the SwedeAmp 

register was calculated using SwedeAmp data as the numerator and IPR data as the 

denominator. 

FINDINGS: The IPR registry recorded 10,788 LLAs across 21 regions (67 hospitals). The 

SwedeAmp documented 5,246 LLAs covering 17 regions (36 hospitals), leaving 5,542 

amputations unaccounted for, mainly due to regions or hospitals not participating in the 

SwedeAmp registry and lower registration rates in some areas. Key findings include: 

• Achieving full coverage in SwedeAmp (17 regions) would require registering 9,305 LLAs. 

• Both men and women over 85 years were significantly underrepresented. 

• Thirteen regions in SwedeAmp obtained more than 40% coverage rate.  

• 5 regions had more than 50% rate of above-knee amputations (range: 50.9% - 68.2%). 

• 8 regions reporting more than 50% rate of below-knee amputations (range: 53.1% - 88.9%).  

• Among the 67 hospitals performing LLAs, 36 reported to SwedeAmp. Six of these hospitals 

performed fewer than 10 LLAs over a six-year period. 

CONCLUSION: SwedeAmp captured 48.6% of initial LLAs in Sweden, highlighting the need for 

improved data completeness in LLA records, especially as only 13 regions achieved over 40% 

Coverage. For hospitals performing regular amputation, the proposed benchmark - coverage of 

≥60%, with ≤36.3% for transfemoral amputation (TF), ≤8.4% for knee disarticulations (KD), and 

≥55.3% for transtibial amputations (TT) – could serve as a target to enhance consistency and 

accuracy in reporting. Expanding coverage can improve the register's utility in tracking 

outcomes, setting national standards, aiding research, and supporting clinical decision-making. 

 

 

ARTICLE INFO 

Received: October 8, 2024 

Accepted: November 12, 2024 

Published: November 19, 2024 
 

CITATION 

Johannesson A.G, Scheving R, Westlund k.L, 

Fridriksson T. Evaluation of the SwedeAmp 

database: Focus on coverage and amputation 

level rates. Canadian Prosthetics & Orthotics 

Journal. 2024; Volume 7, Issue 2, No.2. 

https://doi.org/10.33137/cpoj.v7i2.44089 

KEYWORDS 

Amputation, Rehabilitation, Lower Limb 

Amputation, SwedeAmp, Amputation Rates, 

Sweden, Transfemoral, Transtibial, Knee 

Disarticulation 

DEFINITIONS/ABBREVIATIONS 

AK/BK Ratio: The Ratio of Above-Knee (AK) 

Amputations (TF+KD) to Below-Knee (BK) 

Amputations (TT) Within a Given Population. 

Initial Limb Amputation: The First LLA 

Surgery on a Person's Limb. 

IPR: The Swedish National Inpatient Register. 

NCSP: Nordic Classification of Surgical 

Procedures (Swedish version).  

SCB: Statistics Sweden (official Governmental 

Statistics).  

SwedeAmp: The Amputation and Prosthetics 

Registry for the Lower Limb.  

LLA: Lower Limb Amputation. 

KD: Knee Disarticulation. 

TF: Transfemoral. 

TT: Transtibial. 

 

* CORRESPONDING AUTHOR: 

Anton G. Johannesson, PhD, CPO 

Össur Clinics EMEA, Stockholm, Sweden. 

E-Mail: ajohannesson@ossur.com 

ORCID ID: https://orcid.org/0000-0001-8729-458X 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 7, Issue 2, Article No.2. 2024 

 

 

https://doi.org/10.33137/cpoj.v7i2.44089
https://doi.org/10.33137/cpoj.v7i2.44089
mailto:ajohannesson@ossur.com
https://orcid.org/0000-0001-8729-458X
https://orcid.org/0000-0001-8729-458X
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

Around the year 2000, Swedish authorities recognized the 

importance of using registers for quality control in 

healthcare. As a result, they began supporting the creation 

of new registers and established structured methods for 

financing and certifying these registers. This initiative has 

led to the development of over 100 healthcare registers.3 

The national statistical agency, the Statistics Sweden 

official governmental statistics (SCB), covers a wide range 

of areas, such as demographics, economics, education, 

and labor for Sweden.4 This also includes the Swedish 

National Board of Health and Welfare (Socialstyrelsen) 

registers, responsible for regulating and supervising 

healthcare and social services across Sweden, ensuring 

quality and safety.5 It has administered several national 

registers since the start of inpatient data collection in 1964 

and nationwide registration since 1987 to facilitate Swedish 

healthcare and social services analysis and development.6 

The register's production and quality are monitored, and 

reports on the quality are published regularly.7 This and 

other Swedish registers are based on the Swedish personal 

identity number as an identifier. One of them is the Swedish 

National Inpatient Register (IPR), which includes a broad 

range of surgical operations (LLAs included) performed in 

Sweden since 1998.8 IPR uses the Swedish version of the 

Nordic Classification of Surgical Procedures codes (NCSP) 

for registration.9 It offers data on the number of surgeries 

performed, including LLAs divided into sex, age groups, and 

patient demographics. 

In orthopedics, the Swedish Knee Arthroplasty Register was 

initiated in 1975 and was the first national register to monitor 

the outcome of a specific orthopedic surgical procedure. 

The SwedeAmp register,10 funded by the Swedish 

Association of Local Authorities and Regions, supports 

Sweden's municipalities and regions in delivering public 

services, including healthcare. The SwedeAmp register 

tracks data related to LLA, including limb loss due to 

vascular diseases, trauma, infections, and cancer. They 

focus specifically on rehabilitation with prostheses and 

collecting detailed data on:  

• Amputation levels,  

• Postoperative treatment,  

• Prosthetic fitting, and  

• Functional outcomes, published in a yearly report.11  

 

The coverage of this register has improved since it started 

in 2011, from 16 hospitals covering patient data to include 

36 hospitals (out of 67 that perform LLA) in 2023. Although 

not a nationwide register, it is currently the most extensive 

database related to LLA and outcomes globally and is 

published yearly.12 The SwedeAmp register has already 

shown sex differences concerning amputation level, 

diagnosis, and age, leading to the conclusion that women 

have worse preconditions for successful prosthetic mobility 

after LLA.13 However, the coverage rate has not been fully 

validated. 

The Scottish Physiotherapy Amputee Research Group has 

made comparative register attempts14 reporting on LLAs in 

Scotland since 2015, and the latest report is from 2020-

2021 (A survey of the lower limb amputee population in 

Scotland 2020 and 2021 public report). These can only be 

ordered through their website, and their data have not been 

externally evaluated. In the US, there is a plan by the Mayo 

Clinic to establish a limb loss and preservation registry to 

collect information to improve prevention, treatment, and 

rehabilitation efforts related to limb loss, but no data has 

been published.15   

A recent Swedish study by Jarl et al. highlighted the need 

for a register to monitor LLAs. The study showed a national 

decline in LLA incidence (2008-2017) across most levels, 

except for partial foot amputations. Only 9 of 21 regions saw 

a combined decrease in LLAs, suggesting regional 

variations that merit further study, especially in below-knee 

vs. above-knee amputations.16 Another study by this group 

found higher LLA risks among elderly males with diabetes.17 

One crucial example of how SwedeAmp data can be used 

is understanding the impact of the selection of amputation 

levels and how it affects rehabilitation outcomes. For 

instance, losing the knee joint, as seen in above-or through-

knee amputations, significantly affects the function when a 

person is rehabilitated and uses a prosthesis.18,19 The knee 

joint is critical when it comes to mobility, balance, and life 

quality.20 Its absence requires patients to rely more heavily 

on the hip for movement, leading to slower walking speeds 

and increased energy expenditure.21  

The AK/BK ratio can reveal surgical outcomes between 

clinics or regions. However, choosing the appropriate level 

depends on expertise, experience, and rehabilitation 

planning. Factors such as patient age and high rates of 

dysvascular conditions in certain areas can greatly impact 

both the chosen amputation level and the overall outcomes 

of the procedure.17,22 Trauma or sarcoma-related 

amputations are less common in developed countries and, 

therefore, contribute less to the overall amputation rates.23  

Benchmarking is a relatively new tool for measuring and 

comparing outcomes, recently gaining attention in surgical 

practice.24 To the author's knowledge, it was first introduced 

in relation to lower limb amputation (LLA) in 1996.25 The 

future of benchmarking lies in developing national and 

international registries to establish standardized 

benchmarks. These databases ensure that data collection 

for specific procedures remains current, objective, 

standardized, and comprehensive. These systems allow 

healthcare providers to efficiently identify and monitor 

benchmarked and non-benchmarked interventions, 

creating accurate and relevant benchmarks. Naturally, this 

approach requires a commitment to participating in 

nationally approved data collection efforts.26 

The next step for the SwedeAmp register's could be to 

establish benchmarking and incorporate known 

https://doi.org/10.33137/cpoj.v7i2.44089


 

3 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

confounding factors, such as age, gender, diagnosis, 

comorbidities, postoperative treatments, prosthetic fitting 

technology, and access to rehabilitation, all of which affect 

rehabilitation outcomes after LLA. 

High participation and population coverage in a register are 

critical for establishing a valid benchmark. The coverage 

rate of the SwedeAmp register for LLAs is unknown, while 

the IPR register, however, has a high coverage but only 

includes intervention codes and basic demographics. This 

study aimed to assess SwedeAmp's coverage against the 

more comprehensive nationwide IPR and proposed a 

benchmark based on frequent LLA levels. In subsequent 

studies, we plan to analyze the outcome data from the 

SwedeAmp register in more detail. 

METHODOLOGY 

For this study, data from the IPR register was obtained from 

the period 2018-2023 from the Swedish National Board of 

Health and Welfare. The IPR provides open access data 

using the NCSP codes for registration of amputation levels 

(TF = NFQ19, KD = NGQ09, and TT = NGQ19), divided into 

the 21 regions of Sweden, five-year age groups and sex.8 

Additionally, we applied to the IPR register for a list of all 

Hospitals performing these amputations.  For comparison, 

we applied for data from the SwedeAmp register for the 

same period, utilizing their improved coverage rate and 

including the same parameters. Cooperating with the 

SwedeAmp register, hospitals use an online portal to report 

to the register in 6 different Forms. 

Form 1 and 2 include all levels of LLA from partial toe 

amputation to hemipelvectomy, and Form 3–6 are solely 

focused on amputations at or proximal to TT amputation 

level13 using primarily ISO definitions.27 This data also 

included outcome data that will be used for analysis in later 

studies. For data regarding age and sex, the Official 

Statistics of Sweden (SCB) was used.28 The aim was to 

cross-reference data between the two registers to identify 

discrepancies. In our analysis, all surgical procedures were 

initial LLA performed on a limb. The person could, in theory, 

have been amputated before 1998 (before the start of the 

official IPR data collection), but the person occurs only once 

in our data sets. Due to inconsistent identification, certain 

hospital locations were grouped together to ensure 

database comparability. In the SwedeAmp database, one 

IPR hospital location (Halland Sjukhus) was split into two 

separate hospitals (Varberg and Halmstad). 

Statistics 

Incidence: Patient groups were divided into 5-year age 

intervals, except for those under 45 years old, who were 

grouped together due to the low incidence of LLA in this 

demographic in Sweden. The mean age-group data 

populations were calculated as the mean value for the 

population for each year of the study period (2018-2023). 

This data was sourced from the SCB database.28 The mean 

amputation rates over the same period were obtained from 

the IPR database.8 The overall age-specific incidence rates 

for the initial LLA were thereafter calculated. The overall 

incidence per 100,000 person-years was calculated as the 

number of individuals who had undergone initial LLAs 

divided by the corresponding total population. 

Coverage rate 

The SwedeAmp register's coverage rate was calculated 

using SwedeAmp data as the numerator and IPR data as 

the denominator. 

Benchmarking 

To assess the ratio of amputation levels, we compared the 

average coverage rates from all 36 hospitals reporting to 

SwedeAmp. To control how the coverage rate changed with 

regard to amputation levels we focused on those hospitals 

that obtained 80%, 60%, and 40% coverage rates for 

comparison, using the IPR data as a reference. This 

conclusion is based on the observation that a higher 

coverage rate of over 80% would involve fewer patients and 

hospitals, and a lower percentage (less than 40%) would be 

the opposite scenario. Between 80% and 40% of this data 

formed the basis for establishing benchmark 

recommendations.  

The result is presented stepwise: 

• Overview of the IPR and SwedeAmp registered material 

with regional coverage; 

• Demographics of SwedeAmp population by region; 

• Regional comparison between IPR and SwedeAmp; 

• Coverage rate by SwedeAmp hospitals 

o Comparison based on coverage rates of 80%, 60%, 

and 40%; 

•     Suggestion on a benchmark of amputation levels. 

All statistical analyses were performed using R (R version 

4.3.3, R Foundation for Statistical Computing, Vienna. 

Austria). Both the SwedeAmp and IPR (Inpatient Registry) 

databases were filtered and processed to include only 

relevant information for primary amputations. Various R 

packages were utilized for data manipulation, visualization, 

and statistical analysis. The tidyverse package was 

employed for general data manipulation and visualization 

tasks. The table1 package was used to create summary 

tables, while knitr and kableExtra were utilized to render 

tables in a publication-ready format. For color palettes, the 

RColorBrewer package was used. Spatial data 

manipulation and visualization were achieved using the 

swemaps2 and sf packages. Additionally, the stringr 

package was used for string manipulation.  

Summary tables were created to describe the demographic 

and clinical characteristics of patients undergoing primary 

amputation in different regions.  

https://doi.org/10.33137/cpoj.v7i2.44089


 

4 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

To compare the distribution of demographic and clinical 

characteristics between the SwedeAmp and IPR 

databases, chi-square tests were performed. These tests 

assessed whether there were significant differences in the 

distributions between the two databases. Additionally, linear 

regression models were fitted to examine the relationship 

between coverage ratios and age, as well as coverage 

ratios and year. This analysis helped in understanding how 

coverage ratios varied with these factors. 

Using the kable and kableExtra packages, summary tables 

were created to present data on amputation levels, gender 

distribution, and regional coverage. Spatial maps were 

generated to visualize the coverage of SwedeAmp by 

county and the population distribution by region. Line plots 

were created to show the trends in amputation type 

percentages based on hospital coverage rates and patient 

numbers. 

This study was approved by the regional authorities KVB 

(nr. 152-24),29 and by the Swedish Ethical Review Authority, 

Dnr 2023-05222-01. 

RESULTS 

Overview of the registered material with regional 

coverage 

According to IPR data, 67 hospitals across all 21 regions in 

Sweden performed a total of 10,788 initial LLAs at the TF, 

KD, and TT levels during the study period. 6,127 (56.8%) 

were male, 4,661 (43.2%) were women, averaging 85 

amputations per region per year (range: 16-332). Sixteen of 

these hospitals reporting to IPR performed fewer than 10 

LLAs over the six-year period. The SwedeAmp register 

collected data from 36 hospitals from 17 of the 21 regions 

on 5,246 LLAs during the same period. 2,994 (57.1%) were 

male, 2,252 (42.9%) were women, leaving 5,542 initial 

amputations unaccounted for in the SwedeAmp (Table 1). 

According to the IPR, to achieve full coverage from the 17 

regions, SwedeAmp should have recorded 9,305 initial 

amputations (corresponding to 86.3% of all LLAs) during the 

study period. 

Table 1: A systematic overview of the registered material.  

** Corresponding to the total % of missing data, not the sum of the column.  

Regional coverage 

A coverage map of Sweden's 21 regions shows that 

SwedeAmp primarily lacks data from the northern regions 

and two central regions that have not yet begun registration. 

(Figure 1).  

The incidence of LLAs included in this data (TF, KD, and TT 

amputation only) was 16.5 amputations per 100,000 

person-years. The highest incidence rate was found in men 

older than 80 and women older than 85. In SwedeAmp, 

individuals over the age of 85 were significantly 

underrepresented (Table 2).   

Demographics of SwedeAmp population by region  

The registration revealed consistency and disparity from 

regions reporting into SwedeAmp (Table 3). When three 

regions (Uppsala, Värmlands, and Västerbottens region) 

were excluded due to low registrations, the rate of TF 

amputation varied between 8.8% and 56.1%, the rate of KD 

amputation showed variation between 4.0% and 36.0%, 

and the rate of TT amputation varied between 31.8% and 

86.8%. However, the ratio of amputation side was similar, 

and the median age ranged between 73 and 79 years in 

these regions. Men were more represented in all regions, 

with a ratio of 1.38/1 (range = 51.9% to 72.1%). In the IPR 

database, the ratio was similar, men (n = 6,127) and women 

(n = 4661), resulting in a 1.31/1 ratio. 

Regional comparison 

The data highlights a significant disparity in clinical practice 

regarding the selection of amputation levels. Five regions 

showed a higher ratio of AK amputation (Östergötlands, 

Västra Götalands, Blekinge, Gotlands and Västmanlands). 

The difference was most transparent in Östergötlands and 

Hallands regions in the IPR database and the SwedeAmp 

register, with similar coverage rates. 

      IPR Database Data: 

• Östergötlands region: AK/BK ratio of 1.72/1 (63.3% 

above-knee vs. 36.7% below-knee). 

• Hallands region: AK/BK ratio of 0.69/1 (40.9% 

above-knee vs. 59.1% below-knee). 
 

While the IPR data showed Östergötland favoring above-

knee amputations and Halland favoring below-knee 

amputations, the ratios differ slightly from those reported in 

SwedeAmp. 

 

      SwedeAmp Register Data: 

• Östergötlands region: AK/BK ratio of 2.10/1 (67.7% 

above-knee vs. 32.2% below-knee). 

• Hallands region: AK/BK ratio of 0.54/1 (35.0% 

above-knee vs. 65.0% below-knee). 
 

Still, Östergötland performs a far higher proportion of 

above-knee amputations than Halland region. 

Amputation 
Level 

IPR SwedeAmp* Missing Data 

n  % n % n % 

TF 4,534 42.1 1,828 34.9 2,706 59.7 

KD 800 7.5 438 8.3 362 45.3 

TT 5,454 50.4 2,980 56.8 2,474 45.4 

Sum * 10,788 100 5,246 100 5,542 **51.4 

• * 12 cases excluded due to missing information. 

https://doi.org/10.33137/cpoj.v7i2.44089


 

5 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

 

 

Figure 1: A: Geographical maps showing the Swedish population (by region). B: SwedeAmp coverage rate in % by regions compared to IPR. 

Swedish Population by region

0K

600K

1200K

1800K

2500K

Stockholm

Malmö

Gothenburg

2.45M

Uppsala
0.4M

Södermanland
0.3M

Östergötland
0.47M

Jönköping
0.37M

Kronoberg
0.2M

Kalmar
0.25M

Gotland
0.06M

Blekinge
0.16M

Skåne
1.42M

Halland
0.34M

Västra Götaland
1.77M

Värmland
0.28M

Örebro
0.31M

Västmanland
0.28M

Dalarna
0.29M

Gävleborg
0.29M

Västernorrland
0.24M

Jämtland
0.13M

Västerbotten
0.28M

Norrbotten
0.25M

Coverge of SwedeAmp by county

0%

50%

100%

40.1%

2%

19.7%

87.2%

64.8%

39.8%

19.4%

83.5%

97.5%

80.3%

90.7%

58.3%

5.9%

66.2%

47.6%

56.2%

58.6%

0%

0%

0%

0%

Stockholm

Malmö

Gothenburg

A B

Table 2: Characteristics of the study population stratified into sex and age groups compared with the data from IPR and SwedeAmp (with different 

coverage rates). 

 Standard Population Incidence IPR 
SwedeAmp 

(100%) 
SwedeAmp Hospitals 
With >80% Coverage 

Sex Age-Group 
Average Annual 

Amputations in Sweden 
(2018-2023) 

Average Annual 
Population in Sweden 

(2018-2023) 

Amputation per 
100.000 Person-

Years 

% of Total 
Amputees 

% of Total 
Amputees 

% of Total Amputees 

Men 0-44 22.5 2,967,692 0.8 1.3% 1.3% 1.4% 

Men 45-49 9.3 390,037 2.4 0.5% 0.7% 0.7% 

Men 50-54 21.7 396,103 5.5 1.2% 1.6% 1.6% 

Men 55-59 40.5 382,253 10.6 2.3% 2.5% 2.2% 

Men 60-64 53.7 334,992 16.0 3.0% 3.5% 3.2% 

Men 65-69 90.7 313,105 29.0 5.1% 5.5% 5.3% 

Men 70-74 162.5 307,995 52.8 9.2% 9.5% 9.7% 

Men 75-79 203.7 258,017 78.9 11.5% 11.1% 11.5% 

Men 80-84 184.3 152,914 120.5 10.4% 9.9% 9.7% 

Men 85+* 219.3 114,181 192.1 12.3% 11.3% 10.6% 

Sum 1008.2 5,617,289 17.9 56.8% 57.0% 56.0% 

Women 0-44 13.8 2,789,703 0.5 0.8% 0.8% 0.8% 

Women 45-49 8.0 324,070 2.5 0.5% 0.6% 0.8% 

Women 50-54 9.7 330,276 2.9 0.5% 0.7% 0.7% 

Women 55-59 18.5 319,789 5.8 1.0% 1.1% 0.9% 

Women 60-64 25.0 285,328 8.8 1.4% 1.7% 1.9% 

Women 65-69 47.7 273,753 17.4 2.7% 3.2% 3.4% 

Women 70-74 89.7 277,640 32.3 5.1% 5.0% 5.4% 

Women 75-79 122.8 240,766 51.0 6.9% 7.4% 7.3% 

Women 80-84 136.5 159,630 85.5 7.7% 7.6% 8.2% 

Women 85+* 296.0 170,714 173.4 16.7% 15.0% 14.5% 

Sum 767.7 5,171,668 14.8 43.2% 43.0% 44.0% 

Men + Women 1,775.9 10,788,957 16.5 100% 100% 100% 

*  People over the age of 85 are significantly underrepresented. 

 

 

https://doi.org/10.33137/cpoj.v7i2.44089


 

6 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

 

Table 3: Demographics of the SwedeAmp population by region (n = 17). The Uppsala, Värmland, and Västerbotten regions are excluded from 

further statistical analysis due to their low registration rates. 

  
Dalarnas 
Region 

Jönköpings 
Region 

Östergötlands 
Region 

Skåne Region 
Stockholms 

Region 
Västra Götalands 

Region 

(N=181) (N=294) (N=394) (N=1069) (N=798) (N=1135) 

Amputation Level             

TF 38 (21.0%) 103 (35.0%) 125 (31.7%) 385 (36.0%) 180 (22.6%) 527 (46.4%) 

KD 31 (17.1%) 19 (6.5%) 142 (36.0%) 48 (4.5%) 32 (4.0%) 51 (4.5%) 

TT 112 (61.9%) 172 (58.5%) 127 (32.2%) 636 (59.5%) 586 (73.4%) 557 (49.1%) 

Amputation Side             

Left 83 (45.9%) 148 (50.3%) 189 (48.0%) 527 (49.3%) 374 (46.9%) 568 (50.0%) 

Right 98 (54.1%) 146 (49.7%) 205 (52.0%) 542 (50.7%) 424 (53.1%) 567 (50.0%) 

Age at Amputation             

Mean (SD) 77.9 (10.8) 76.3 (13.1) 74.9 (13.1) 75.9 (12.1) 77.3 (12.7) 76.1 (12.9) 

Median [Min, Max] 79 [26, 101] 78 [24, 101] 77 [22, 99] 78 [20, 101] 79 [22, 101] 78 [21, 100] 

Gender             

Women 72 (39.8%) 138 (46.9%) 183 (46.4%) 447 (41.8%) 334 (41.9%) 525 (46.3%) 

Men 109 (60.2%) 156 (53.1%) 211 (53.6%) 622 (58.2%) 464 (58.1%) 610 (53.7%) 

Year             

2018 34 (18.8%) 69 (23.5%) 58 (14.7%) 185 (17.3%) 115 (14.4%) 134 (11.8%) 

2019 26 (14.4%) 63 (21.4%) 64 (16.2%) 185 (17.3%) 152 (19.0%) 217 (19.1%) 

2020 29 (16.0%) 41 (13.9%) 69 (17.5%) 145 (13.6%) 130 (16.3%) 158 (13.9%) 

2021 29 (16.0%) 27 (9.2%) 55 (14.0%) 161 (15.1%) 83 (10.4%) 183 (16.1%) 

2022 37 (20.4%) 50 (17.0%) 77 (19.5%) 198 (18.5%) 122 (15.3%) 239 (21.1%) 

2023 26 (14.4%) 44 (15.0%) 71 (18.0%) 195 (18.2%) 196 (24.6%) 204 (18.0%) 

  
  

Blekinge 
Region 

Gävleborgs 
Region 

Gotlands Region 
Hallands 
Region 

Örebro Region 
Västmanlands 

Region 

(N=195) (N=177) (N=81) (N=380) (N=231) (N=107) 

Amputation Level             

TF 103 (52.8%) 49 (27.7%) 34 (42.0%) 106 (27.9%) 62 (26.8%) 60 (56.1%) 

KD 11 (5.6%) 26 (14.7%) 12 (14.8%) 27 (7.1%) 16 (6.9%) 13 (12.1%) 

TT 81 (41.5%) 102 (57.6%) 35 (43.2%) 247 (65.0%) 153 (66.2%) 34 (31.8%) 

Amputation Side             

Left 99 (50.8%) 91 (51.4%) 41 (50.6%) 192 (50.5%) 109 (47.2%) 57 (53.3%) 

Right 96 (49.2%) 86 (48.6%) 40 (49.4%) 188 (49.5%) 122 (52.8%) 50 (46.7%) 

Age at Amputation             

Mean (SD) 78.0 (11.7) 73.9 (14.1) 77.2 (11.1) 78.4 (11.1) 76.4 (10.5) 77.0 (12.7) 

Median [Min, Max] 79 [21, 99] 75 [22, 98] 79 [45, 93] 79 [30, 101] 78 [41, 98] 79 [21, 98] 

Gender             

Women 74 (37.9%) 76 (42.9%) 39 (48.1%) 155 (40.8%) 102 (44.2%) 39 (36.4%) 

Men 121 (62.1%) 101 (57.1%) 42 (51.9%) 225 (59.2%) 129 (55.8%) 68 (63.6%) 

Year             

2018 27 (13.8%) 9 (5.1%) 15 (18.5%) 45 (11.8%) 47 (20.3%) 12 (11.2%) 

2019 34 (17.4%) 10 (5.6%) 16 (19.8%) 58 (15.3%) 44 (19.0%) 14 (13.1%) 

2020 37 (19.0%) 42 (23.7%) 9 (11.1%) 62 (16.3%) 48 (20.8%) 22 (20.6%) 

2021 30 (15.4%) 38 (21.5%) 7 (8.6%) 78 (20.5%) 28 (12.1%) 18 (16.8%) 

2022 30 (15.4%) 31 (17.5%) 14 (17.3%) 56 (14.7%) 33 (14.3%) 21 (19.6%) 

2023 37 (19.0%) 47 (26.6%) 20 (24.7%) 81 (21.3%) 31 (13.4%) 20 (18.7%) 

   
Kalmar Region 

Kronobergs 
Region 

Södermanlands 
Region 

Uppsala Region 
Värmlands 

Region 

(N=47) (N=68) (N=64) (N=9) (N=16) 

Amputation Level           

TF 17 (36.2%) 6 (8.8%) 27 (42.2%) 1 (11.1%) 5 (31.3%) 

KD 4 (8.5%) 3 (4.4%) 3 (4.7%) 0 (0%) 0 (0%) 

TT 26 (55.3%) 59 (86.8%) 34 (53.1%) 8 (88.9%) 11 (68.8%) 

Amputation Side           

Left 25 (53.2%) 33 (48.5%) 33 (51.6%) 5 (55.6%) 6 (37.5%) 

Right 22 (46.8%) 35 (51.5%) 31 (48.4%) 4 (44.4%) 10 (62.5%) 

Age at Amputation           

Mean (SD) 70.3 (16.4) 75.0 (10.4) 75.8 (11.3) 65.9 (14.9) 66.9 (8.59) 

Median [Min, Max] 73 [22, 94] 77 [41, 92] 77 [50, 92] 65 [44, 89] 69 [47, 81] 

Gender           

Women 19 (40.4%) 19 (27.9%) 25 (39.1%) 0 (0%) 5 (31.3%) 

Men 28 (59.6%) 49 (72.1%) 39 (60.9%) 9 (100%) 11 (68.8%) 

Year           

2018 10 (21.3%) 9 (13.2%) 0 (0.0%) 3 (33.3%) 1 (6.3%) 

2019 6 (12.8%) 12 (17.6%) 0 (0.0%) 1 (11.1%) 0 (0.0%) 

2020 20 (42.6%) 8 (11.8%) 3 (4.7%) 1 (11.1%) 9 (56.3%) 

2021 3 (6.4%) 12 (17.6%) 2 (3.1%) 2 (22.2%) 2 (12.5%) 

2022 2 (4.3%) 9 (13.2%) 20 (31.3%) 2 (22.2%) 0 (0.0%) 

2023 6 (12.8%) 18 (26.5%) 39 (60.9%) 0 (0.0%) 4 (25.0%) 

 

https://doi.org/10.33137/cpoj.v7i2.44089


 

7 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

Comparison using ≥40% coverage rate  

Data from SwedeAmp, from 13 regions in Sweden that 

obtained at least ~40% coverage of the IPR register, was 

used for further analysis (Table 4). In total, these regions in 

SwedeAmp registered 5,110 amputations (61.8% 

coverage), 2,901 TT (56.7%), 1,778 TF (34.8%), and 431 

KD (8.4%), of which 2,907 (56,9%) were male and 2,203 

(43,1%) women. The IPR registered during the same period 

8,262 amputations (4,266 TT (51.6%), 3,280 TF (39.7%), 

and 716 KD (8.7%), of which 4,736 (57.3%) were male and 

3,526 (42.7%) women. 

When analyzing the coverage ratio by age groups, the older 

the patients were, the higher the risk of not being included 

in the data from SwedeAmp (Figure 2). The hospital 

coverage ratio by year showed that despite the impact of 

the pandemic in 2021, coverage still rises yearly (Figure 3). 

SwedeAmp coverage rate by hospitals 

Thirty-six out of the 67 hospitals were included in the 

SwedeAmp database. Two hospitals in the SwedeAmp 

register were reported as one hospital in the IPR database 

(Table 5).  

The SwedeAmp register collected 5246 cases during the 

study period from 36 hospitals. On average, 24 patients 

went through LLA per year and hospital (range = 0.2 – 

112.7). However, six hospitals performed less than ten 

LLAs (26 LLAs in total). Excluding these hospitals, the 

average yearly number will rise to 29 persons per year and 

hospital (n = 30 hospitals, 5220 patients, range = 2.0-112.7) 

(Table 5). 

Six hospitals reported over 90% of amputations: 1,817 out 

of 1,936 (93.9% coverage rate). Four more hospitals 

reported between 80% to 89% of amputations: 769 out of 

921 (83.5%). Fourteen hospitals reported 40% - 79% 

amputation: 2,159 out of 3,303 (65.1% coverage rate). In 

total, 24 hospitals obtained a coverage rate of ≥40% (Table 

5). 

Suggestion on a benchmark of amputation levels 

We calculated the ratio using hospital reports to SwedeAmp 

with a coverage rate of more than 60% for one or more 

years (N = 36). The data includes a total of 4,419 

amputations. With a suggested minimum coverage rate of 

≥60%, the proposed benchmark ratios were ≤34.3% for 

transfemoral (TF) amputations, ≤8.4% for knee 

disarticulations (KD, where the knee joint is lost), and 

≥55.3% for transtibial (TT) amputations. Minimal ratio 

changes were observed when using coverage rates of 80% 

or 40% (Table 6). 

DISCUSSION 

The SwedeAmp register covered 48.6% of all lower limb 

amputations (LLAs) performed during the study period, 

representing 17 out of 21 regions in Sweden and 5,246 

cases. The four non-participating regions were in northern 

Sweden, three of which are the largest by area. While these 

regions have lower population densities, this alone does not 

fully explain their absence from the register. In total, eight 

regions either do not report to the register or have less than 

20% coverage. Data from 36 hospitals (53.7%) out of the 67 

performing LLAs across the 21 regions were included in the 

registry between 2018 and 2023. 

This study's incidence report using the IPR database was 

lower than previous studies (17) as it only represents the 

TT, KD, and TF amputation levels. However, we also looked 

at the trend from 2008 to 2023 using the IPR database, and 

gladly, the incidence is declining, even after 2018.8 

The reported data showed a notable trend of older patients 

being underrepresented. This may be due to the focus of 

healthcare professionals involved in the rehabilitation 

phase, who tend to concentrate on the outcomes of their 

patients rather than on those who are not enrolled in 

intensive rehabilitation program or who pass away shortly 

after surgery.  

 

Figure 2: SwedeAmp coverage ratio by age groups (2018-2023). 

20 30 40 50 60 70 80 90

0
.4

0
0

.4
5

0
.5

0
0
.5

5
0
.6

0
0
.6

5
0
.7

0
0
.7

5

SwedeAmp coverage ratio by Age groups (2018 - 2023)

Age (groups)

C
o

v
e

ra
g

e
 r

a
ti

o

Age / ratio Regression Line

Ratio = 0.703 -0.0028  * Age

p (age) = 0.014

 

Figure 3: SwedeAmp coverage ratio trends (2018–2023). 

2018 2019 2020 2021 2022 2023

0
.0

0
.2

0
.4

0
.6

0
.8

1
.0

SwedeAmp coverage ratio by Year (2018 - 2023)

Year

C
o

v
e

ra
g

e
 r

a
ti

o

Year / ratio Regression Line

Ratio = -52.215  +  0.0261  * Age

p (Year) = 0.062

SwedeAmp coverage ratio trends (2018–2023). 

SwedeAmp coverage ratio by age groups (2018-2023) 

https://doi.org/10.33137/cpoj.v7i2.44089


 

8 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

Interestingly, out of the 13 regions that reported more than 

20% coverage rate, one region (Östergötland) reported a 

36.0% rate of KD amputations, while four regions reported 

between 12.1 % and 17.1%, and the remaining eight 

regions were all below 8.5% of all LLAs. A notable 

difference was found related to the AK/BK ratio, where two 

regions, Västmanland (56.1%) and Blekinge (52.8%), 

reported that more than half of all amputations were 

performed on the TF level. Additionally, three more regions 

reported a higher AK/BK ratio (when the KD level is 

included), while seven regions reported a reverse AK/BK 

ratio. These regions have a substantial number of LLAs and 

high coverage, with median age and range similar to other 

regions with different ratios. No significant age-related 

differences were observed between the cohorts. These 

disparities warrant further exploration and may justify using 

amputation levels as a benchmark for comparison.  

However, there is an indication that patients not reported to 

SwedeAmp were from the oldest age group in the 

population. The question is not whether the 49% of missing 

data confounds the material represented in the SwedeAmp 

reports; it's more related to how much it affects. The effect 

can be addressed differently. We have demonstrated that 

although data is missing, the level of amputations in 

hospitals showed similar disparities when using 80% 

coverage compared with 40% coverage.  

The average of 29 initial amputations per year and hospital, 

ranging from 2.0 to 112.7 patients, is noteworthy. According 

to the IPR register, sixteen hospitals performed fewer than 

ten amputations over six years, including six in the 

SwedeAmp register. Due to these low numbers, these 

hospitals were excluded from further statistical analysis.  

Further investigation is needed to determine whether the 

volume of procedures at these hospitals impacts patient 

outcomes compared to hospitals that perform LLAs more 

frequently, or if this discrepancy could be due to incorrect 

registrations. These findings revealed the question of 

whether LLAs should be considered a specialized are of 

focus to improve the outcome in the future.  

The SwedeAmp initiative, based on hospitals’ voluntary 

participation, focuses on patient-centered care by tracking 

clinical outcomes, patient satisfaction, quality of life, and 

functional mobility. 

Although no guidelines on LLA in Sweden are available, 

benchmarking against best practices or, as here, using the 

outcome data from SwedeAmp could help reduce variability 

and ensure that patients receive the most appropriate level 

of amputation. 

Table 4: Table 4: List of regions included in the coverage analysis (regions with at least 40% coverage in the SwedeAmp register are specified 

and included in the further analysis on amputation levels). 

Region Subjects in IPR Database 
Subjects in SwedeAmp 

Database 
SwedeAmp Coverage (%) Included in Analysis 

Blekinge län 200 195 97.5 Yes 

Dalarnas län 322 181 56.2 Yes 

Gotlands län 97 81 83.5 Yes 

Gävleborgs län 302 177 58.6 Yes 

Hallands län 419 380 90.7 Yes 

Jämtlands län 165 0 0.0 No 

Jönköpings län 454 294 64.8 Yes 

Kalmar län 242 47 19.4 No 

Kronobergs län 171 68 39.8 Yes 

Norrbottens län 474 0 0.0 No 

Skåne län 1,332 1,069 80.3 Yes 

Stockholms län 1,992 798 40.1 Yes 

Södermanlands län 325 64 19.7 No 

Uppsala län 443 9 2.0 No 

Värmlands län 271 16 5.9 No 

Västerbottens län 275 0 0.0 No 

Västernorrlands län 331 0 0.0 No 

Västmanlands län 225 107 47.6 Yes 

Västra Götalands län 1,947 1,135 58.3 Yes 

Örebro län 349 231 66.2 Yes 

Östergötlands län 452 394 87.2 Yes 

Sum 10,788 5,246  (5,110) * 

* Data from SwedeAmp, covering ~40% of the IPR register across 13 Swedish regions, included 5,110 registered amputations for analysis. 

https://doi.org/10.33137/cpoj.v7i2.44089


 

9 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

Addressing these differences allows healthcare providers to 

provide more consistent and equitable treatment for 

patients undergoing LLA nationwide. However, a key 

challenge for SwedeAmp, as highlighted in this study, is 

ensuring consistent data reporting from all healthcare 

providers. Reporting gaps can hinder nationwide 

conclusions and obscure certain trends.  

Table 5: List of hospitals performing LLAs and represented in both IPR and SwedeAmp data (n=36).   

Hospital Patients in IPR Patients in SwedeAmp Coverage Rate (%) 

Akademiska sjukhuset Uppsala 441 9 2,0 

Blekingesjukhuset 200 195 97,5 

Capio S:t Görans sjukhus 258 181 70,2 

Centrallasarettet Växjö 143 68 47,6 

Centralsjukhuset Karlstad 238 16 6,7 

Centralsjukhuset Kristianstad 212 182 85,8 

Danderyds sjukhus 405 253 62,5 

Falu lasarett 234 181 77,4 

Hallands sjukhus* 419 380 90,7 

Helsingborgs lasarett 290 195 67,2 

Hudiksvalls sjukhus 101 2 2,0 

Hässleholms sjukhus 2 1 50,0 

Höglandsjukhuset Eksjö 157 84 53,5 

Karolinska Univ sjukhuset (Huddinge + Solna) 461 170 36,9 

Kungälvs sjukhus 32 12 37,5 

Lasarettet i Motala 78 37 47,4 

Länssjukhuset Ryhov Jönköping 214 209 97,7 

Länssjukhuset i Kalmar 157 34 21,7 

Mälarsjukhuset i Eskilstuna 229 60 26,2 

Norrtälje sjukhus 107 9 8,4 

Nyköpings lasarett 93 4 4,3 

Sahlgrenska Univ sjukhus (Göteborg + Mölndal) 704 525 74,6 

Sjukhuset i Gävle 200 175 87,5 

Skånes Univ.sjukhus (Malmö + Lund) 723 676 93,5 

Södersjukhuset 669 141 21,1 

Södertälje Sjukhus 91 44 48,4 

Södra Älvsborgs sjukhus Borås 357 267 74,8 

Uddevalla NÄL 411 331 80,5 

Univ sjukhuset Linköping 192 186 96,9 

Univ sjukhuset Örebro 339 231 68,1 

Visby lasarett 97 81 83,5 

Vrinnevisjukhuset i Norrköping 182 171 94,0 

Värnamo sjukhus 83 1 1,2 

Västerviks sjukhus 85 13 15,3 

Västmanlands sjukhus Västerås 225 107 47,6 

Ystad Lasarett 91 15 16,5 

Sum 8,920 5,246  

* Including two hospitals in the SwedeAmp register: Halmstad and Varberg. 

 

 Table 6: SwedeAmp amputations by level in all, 80%, 60%, and 40% hospital coverage rates. 

Amputation 
Level 

Count in All Ratio in All 
Count in 
Hospitals 

Ratio in 
Hospitals 

Count in 
Hospitals 

Ratio in 
Hospitals 

Count in 
Hospitals 

Ratio in 
Hospitals 

All Hospitals (N = 36) >80% (N = 10) >60% (N = 17) >40% (N = 24) 

TF 1,828 34.9% 932 36.0% 1,603 36.3% 1,699 35.7% 

KD 438 8.4% 267 10.3% 373 8.4% 415 8.72% 

TT 2,980 56.8% 1,387 53.6% 2,443 55.3% 2,646 55.6% 

Total 5,246 100% 2,586 100% 4,419 100% 4,760 100% 

 

 

https://doi.org/10.33137/cpoj.v7i2.44089


 

10 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

International comparisons of SwedeAmp data are primarily 

limited to Scottish reports,14 as no other comparable 

registries exist. Notable discrepancies arise when 

comparing the initial level of amputation between these 

registries. In Scotland, 60% of amputations are TT, 1% are 

KD, and 39% are TF amputations,14 compared to 56.8%, 

8.3%, and 34.9% in SwedeAmp, respectively. Additionally, 

the average age of LLA in Scotland is 67 years, which is ten 

years younger than the average age in Sweden.16 

A deeper analysis of the patient characteristics and clinical 

decision-making processes in different geographic regions 

worldwide and within Sweden could provide insights into the 

factors driving the current discrepancies. This might involve 

looking closer at age, gender, comorbidities, and the 

availability of limb-salvage interventions. SwedeAmp data 

has the potential to become a valuable resource for 

exploring how social determinants of health influence post-

amputation recovery and rehabilitation outcomes.  

Benchmarking levels can be justified in several ways.26 In 

this study, we selected those hospitals with adequate 

registration coverage when comparing the IPR with 

SwedeAmp. Another approach would be to choose the 

'best' hospital, defined by high volume, a low AK/BK ratio, 

and low mortality rates for amputations, and use that as the 

benchmark. However, the same result would have been 

obtained since high-volume centers have similar ratios. 

A third approach involves selecting a 'perfect' candidate for 

amputation and benchmarking based on those cases. 

However, this approach is less realistic for LLAs due to age 

variations and the high comorbidity burden in this 

population. A potential limitation of this study is the 

discrepancy between the data provided by the 

administration managing the IPR register (Swedish National 

Board of Health and Welfare) and the online data from the 

same database, which showed a difference of 168 cases 

(1.6%). According to the data provider, this discrepancy 

may be due to instances where the same patient undergoes 

amputations at different hospitals, with each hospital 

independently registering the procedure. Another limitation 

is the uncertainty regarding the impact of population 

ethnicity and regional comorbidity rates, both of which are 

known to influence outcomes following LLA. Additionally, 

outcomes can be affected by factors such as 

socioeconomic status, healthcare access, and genetic 

predispositions, which are not fully accounted for in the 

current SwedeAmp register.30  

These findings highlighted the need for broader SwedeAmp 

participation to achieve comprehensive, reliable nationwide 

data on LLAs. Expanded participation strengthens 

SwedeAmp's value as a research resource, allowing for 

deeper insights into procedural efficacy, regional disparities, 

and patient care improvements. This will ultimately promote 

higher standards in both local and national healthcare. 

CONCLUSION 

The SwedeAmp register encompasses over half of all 

amputations documented in the IPR database. This study 

underscored the variations observed in both registries, 

particularly concerning lower limb amputations (LLAs) in 

terms of age, amputation levels, and geographic 

distribution. Notable differences in the above-knee (AK) to 

below-knee (BK) amputation ratios were identified across 

various regions. Additionally, our findings indicated 

inconsistencies in age group representation within the 

SwedeAmp data. Based on the insights from the 

SwedeAmp data, we have proposed benchmark 

recommendations regarding amputation levels of ≤36.3% 

for TF, ≤8.4% for KD, and ≥55.3% for TT amputations. 

ACKNOWLEDGEMENTS 

We would like to extend our sincere thanks to the Steering Group 

of SwedeAmp for granting us access to their data for analysis. 

DECLARATION OF CONFLICTING INTERESTS 

Anton G. Johannesson is an employee of Össur Clinics, which 

provides services to prosthetic and orthotics clinics. Reynir 

Scheving, Karolin Lindgren Westlund, and Thor Fridriksson 

are all employed by Össur Iceland ehf, Medical Office in Reykjavik, 

Iceland. 

AUTHORS CONTRIBUTION 

• Anton G. Johannesson: Conceptualization; Study oversight; 

Data analysis; Writing original; Review and editing. 

• Reynir Scheving: Conceptualization; Study oversight; Data 

analysis; Review and editing. 

• Karolin Lindgren Westlund: Conceptualization; Study 

oversight; Review and editing. 

• Thor Fridriksson: Conceptualization; Study oversight; Review 

and editing. 

All authors reviewed the manuscript and approved the final version. 

 

SOURCES OF SUPPORT 

No external support was obtained for this project. 

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11 

Johannesson A.G, Scheving R, Westlund k.L, Fridriksson T. Evaluation of the SwedeAmp database: Focus on coverage and amputation level rates. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.2. https://doi.org/10.33137/cpoj.v7i2.44089 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X EVALUATION OF THE SWEDEAMP DATABASE  

Johannesson et al., 2024 

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