International Variations in Amputation Practice: A VASCUNET Report

Area of Science:

• Vascular Surgery
• Public Health
• Epidemiology

Background:

• Peripheral arterial disease (PAD) and diabetes mellitus are leading causes of lower limb amputations worldwide.
• International variations in amputation rates and practice patterns necessitate comparative studies.

Purpose of the Study:

• To investigate international differences in the incidence and practice patterns of lower limb amputations.
• To analyze time trends in amputations related to PAD and/or diabetes mellitus across different countries.

Main Methods:

• Utilized population-based administrative data from 12 European and Australasian countries (VASCUNET collaboration) for 2010-2014.
• Analyzed amputation rates, time trends, mortality (in-hospital/30-day), and healthcare reimbursement systems.

Main Results:

• Major amputation incidence varied significantly (7.2-41.4/100,000), with an overall declining trend except in Slovakia.
• Minor amputations showed an increasing trend; individuals aged ≥65 years were up to 4.9 times more likely to undergo amputation.
• Mortality rates ranged from 6.3% (Finland) to 20.3% (Hungary); fee-for-service systems correlated with lower major amputation incidence.

Conclusions:

• Significant geographical disparities exist in major amputation rates, with an overall decline observed.
• Variations in diabetes prevalence, age demographics, and mortality underscore the need for context-specific limb salvage interventions.
• Further research is crucial to optimize limb salvage across diverse demographic settings, despite registry data limitations.