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

Abstract

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 60years 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 avascular surgery department in arural 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: 65-74years-total, 12.38%; 75years and older-total, 13.85%; average age, 48.36years (population density, 56.4/km2). According to the SA Association of Statutory Health Insurance Physicians, there were 605patients for every doctor in Burg (SA) in 2019.There was atotal of 5087 people in need of long-term care in the district in 2019. With such alow population density, low doctor density, high mean age, high proportion of people over 75years of age and ahigh 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 stageIV (FONTAINE) in the initial patient clientele.Every establishment of avascular surgery department is associated with aconsiderable 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 arural area with low population and doctor density allows investment in the establishment of anew 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 arelevant revenue outlook.