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

Abstract

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. Retrospective study. One university and five county hospitals, Finland. All referrals to the university hospital vascular surgical unit for chronic critical lower limb ischaemia and the number of major amputations in the region. Numbers of new vascular surgical consultations and amputations in 11 municipalities. Correlation between numbers of consultations and amputations. Between the subregions the age-standardised incidence of new vascular surgical consultations in the 15-85 year old population varied from 52.4 to 104.7/10(5) and the incidence of amputation from 10.2 to 24.8/10(5). 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). An active referral policy leads to reduced amputation rates.