Regional differences in the use of a vascular surgical service and incidence of amputations in a well-defined geographical area

Abstract

Objective: To evaluate regional differences in the use of a vascular surgical service in the treatment of critical lower limb ischaemia and incidence of amputation in the 1990s in a well-defined geographical area.

Design: Retrospective study.

Setting: One university and five county hospitals, Finland.

Subjects: All referrals to the university hospital vascular surgical unit for chronic critical lower limb ischaemia and the number of major amputations in the region.

Main outcome measures: Numbers of new vascular surgical consultations and amputations in 11 municipalities. Correlation between numbers of consultations and amputations.

Results: Between the subregions the age-standardised incidence of new vascular surgical consultations in the 15–85 year old population varied from 52.4 to 104.7/10⁵ and the incidence of amputation from 10.2 to 24.8/10⁵. There was an inverse correlation between the numbers of consultations and amputations. The most significant inverse correlation was between consultations and below knee amputations in diabetic patients (r = −0.70). For above knee amputations there was no correlation (r = −0.21).

Conclusion: An active referral policy leads to reduced amputation rates.