[Vascular surgery care in rural areas-Adaptation to demographic and epidemiological requirements]

The demographic development in Germany, especially in Saxony-Anhalt (SA), also poses challenges for vascular surgery, as the incidence of vascular diseases has increased following demographic change. For example, the prevalence of peripheral arterial occlusive disease (PAOD) in industrialised countries is estimated at around 10-20% in people over 60 years of age; thus, the number of people affected will also increase here with demographic change. Especially in rural areas, it seems to be more difficult for patients to reach appropriate specialist treatment.

A compact narrative brief review, based on selective references from the current medical-scientific literature and our own experiences from daily practice in setting up a vascular surgery department in a rural area.

In 2020, the population in the rural district of Jerichower Land (SA) was approximately 89,403 (male: 44,489; female: 44,914). The age distribution in the age groups relevant for PAOD is as follows: 65-74 years-total, 12.38%; 75 years and older-total, 13.85%; average age, 48.36 years (population density, 56.4/km²). According to the SA Association of Statutory Health Insurance Physicians, there were 605 patients for every doctor in Burg (SA) in 2019.There was a total of 5087 people in need of long-term care in the district in 2019. With such a low population density, low doctor density, high mean age, high proportion of people over 75 years of age and a high number of people in need of care, limited mobility and accessibility to vascular surgery care are to be expected, which was also reflected in the high number of PAOD of stage IV (FONTAINE) in the initial patient clientele.Every establishment of a vascular surgery department is associated with a considerable financial and material investment, which the provider of the facility must be prepared to make.In addition to the material investment, the availability of appropriately qualified staff to implement and maintain continuity of care must also be seriously considered.

The high proportion of residents at risk of and suffering from PAOD in a rural area with low population and doctor density allows investment in the establishment of a new vascular surgery department to ensure local care in this patient group with limited mobility and self-help, thus, ultimately from an appropriate health policy perspective but also from the perspective of a relevant revenue outlook.