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International Variations in Amputation Practice: A VASCUNET Report

Artikel i vetenskaplig tidskrift
Författare C. A. Behrendt
B. Sigvant
Z. Szeberin
B. Beiles
N. Eldrup
I. A. Thomson
M. Venermo
M. Altreuther
G. Menyhei
Joakim Nordanstig
M. Clarke
H. C. Riess
M. Bjorck
E. S. Debus
Publicerad i European Journal of Vascular and Endovascular Surgery
Volym 56
Nummer/häfte 3
Sidor 391-399
ISSN 1078-5884
Publiceringsår 2018
Publicerad vid Institutionen för medicin
Sidor 391-399
Språk en
Länkar dx.doi.org/10.1016/j.ejvs.2018.04.0...
Ämnesord Peripheral arterial disease (PAD), Diabetic foot syndrome (DFS), Lower extremity amputation, lower-extremity amputations, peripheral arterial-disease, critical limb, ischemia, editors choice, collaboration, guidelines, nationwide, patterns, surgery, trends, Surgery, Cardiovascular System & Cardiology
Ämneskategorier Invärtesmedicin

Sammanfattning

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. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

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