Background: Transtibial amputation and subsequent prosthetic fitting can cause prolonged hospital length of stay (LOS). Recently, a two-staged admission pathway for new transtibial amputees was introduced in a local hospital to shorten hospital LOS. Methods: A retrospective cohort study was performed to review the 5-year outcomes of major lower extremity amputation in a local hospital and to compare the difference in LOS and functional outcomes between traditional (group 1) and two-staged (group 2) admission pathways for new transtibial amputees. Results: The fitting rate was 55% in transtibial amputees, 14% in transfemoral amputees, and only 3.7% in dementia patients. For new transtibial amputees, the mean postoperative LOS was significantly reduced by 32.8 days in group 2. Besides, more patients in group 2 were able to walk without aid. Conclusion: LOS for new transtibial amputees can be greatly reduced by the two-staged admission pathway to minimize hospital operational cost.