International Variations in Amputation Practice – A VASCUNET Report

International Variations in Amputation Practice – A VASCUNET Report

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 the VASCUNET collaboration. Amputation rates, time-trends, in-hospital or 30-days 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 4.2% (Slovakia) to 20.7% (Germany) and diabetes prevalence among amputees from 25.7% (Finland) to 74.3% (Slovakia). Mean incidence of major amputation varied between 7.2/100 000 (New Zealand) to 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 to 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 lower incidence of major amputation compared to countries with a population based reimbursement system (14.3/100 000 versus 18.4/100 000, respectively, p<0.001).

Conclusions: This international audit showed large geographical differences in major amputation rates, almost by a factor six, and an overall declining time-trend during the four-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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