Christian-Alexander Behrendt1, Birgitta Sigvant2, Zoltán Szeberin3, Barry Beiles4, Nikolaj Eldrup5, Ian A Thomson6, Maarit Venermo7, Martin Altreuther8, Gabor Menyhei9, Joakim Nordanstig10, Mike Clarke11, Henrik Christian Rieß12, Martin Björck2, Eike Sebastian Debus12. 1. Department of Vascular Medicine, University Heart Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. Electronic address: ch.behrendt@uke.de. 2. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 3. Department of Vascular Surgery, Semmelweis University, Budapest, Hungary. 4. Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia. 5. Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark. 6. Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand. 7. Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. 8. Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway. 9. Department of Vascular Surgery, Pecs University Medical Centre, Pecs, Hungary. 10. Department of Vascular Surgery and the Institute of Medicine at the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. 11. Northern Vascular Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK. 12. Department of Vascular Medicine, University Heart Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Abstract
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.
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.
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