International Variations in Amputation Practice: A VASCUNET Report

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Christian-Alexander Behrendt, Department of Vascular Medicine, University Heart Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. Electronic address: ch.behrendt@uke.de.
  • ,
  • Birgitta Sigvant, Department of Surgical Sciences, Thoracic Surgery, Uppsala University, Uppsala, Sweden.
  • ,
  • Zoltán Szeberin, Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
  • ,
  • Barry Beiles, Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia.
  • ,
  • Nikolaj Eldrup
  • ,
  • Ian A Thomson, Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand.
  • ,
  • Maarit Venermo, Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
  • ,
  • Martin Altreuther, Department of Vascular Surgery, St Olavs Hospital, Trondheim, Norway.
  • ,
  • Gabor Menyhei, Department of Vascular Surgery, Pecs University Medical Centre, Pecs, Hungary.
  • ,
  • Joakim Nordanstig, Department of Vascular Surgery and the Institute of Medicine at the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
  • ,
  • Mike Clarke, Northern Vascular Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
  • ,
  • Henrik Christian Rieß, Department of Vascular Medicine, University Heart Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
  • ,
  • Martin Björck, Department of Surgical Sciences, Thoracic Surgery, Uppsala University, Uppsala, Sweden.
  • ,
  • Eike Sebastian Debus, Department of Vascular Medicine, University Heart Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

OBJECTIVES: To study international differences in incidence and practice patterns as well as time trends in lower limb amputations related to peripheral arterial disease and/or diabetes mellitus.

METHODS: Data on lower limb amputations during 2010-2014 were collected from population based administrative data from countries in Europe and Australasia participating in the VASCUNET collaboration. Amputation rates, time trends, in hospital or 30 day mortality and reimbursement systems were analysed.

RESULTS: Data from 12 countries covering 259 million inhabitants in 2014 were included. Individuals aged ≥ 65 years ranged from 12.9% (Slovakia) to 20.7% (Germany) and diabetes prevalence among amputees from 25.7% (Finland) to 74.3% (Slovakia). The mean incidence of major amputation varied between 7.2/100,000 (New Zealand) and 41.4/100,000 (Hungary), with an overall declining time trend with the exception of Slovakia, while minor amputations increased over time. The older age group (≥65 years) was up to 4.9 times more likely to be amputated compared with those younger than 65 years. Reported mortality rates were lowest in Finland (6.3%) and highest in Hungary (20.3%). Countries with a fee for service reimbursement system had a lower incidence of major amputation compared with countries with a population based reimbursement system (14.3/100,000 versus 18.4/100,000, respectively, p < .001).

CONCLUSIONS: This international audit showed large geographical differences in major amputation rates, by a factor of almost six, and an overall declining time trend during the 4 year observation of this study. Diabetes prevalence, age distribution, and mortality rates were also found to vary between countries. Despite limitations attributable to registry data, these findings are important, and warrant further research on how to improve limb salvage in different demographic settings.

OriginalsprogEngelsk
TidsskriftEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Vol/bind56
Nummer3
Sider (fra-til)391-399
Antal sider9
ISSN1078-5884
DOI
StatusUdgivet - 2018

Se relationer på Aarhus Universitet Citationsformater

ID: 127797867