Vascular surgery trends in Australia: 2001-2015: less open surgery, less limb loss and more endovascular intervention.

Abstract

The prevalence of peripheral arterial disease (PAD) in Australia is currently poorly characterized. The risk factor profile for PAD is changing with the population ageing, diabetes increasing and smoking rates declining. The management of PAD is also evolving, with advances in medical management and endovascular technique. The trends in PAD prevalence and surgical management have implications for preventative medicine, the Australian health system and vascular surgery. We report and analyse trends in PAD surgical intervention performed between 2001 and 2015. Data was extracted from the National Hospital Morbidity Database procedural item code records. Procedural numbers of endovascular lower extremity revascularization (LER); open LER; minor and major lower extremity amputations (LEA) between 2001 and 2015 in adults ≥45 years were included. Results were population-adjusted and age-stratified using census information from the Australian Bureau of Statistics to analyse changes in intervention rates. Linear regression analyses were performed to calculate the average annual change in procedures per capita (100 000). From 2001 and 2015, per capita (100 000 population) volume of endovascular LER increased 89%, open LER decreased 70%, major LEA decreased 65% and minor LEA increased 14%. The most remarkable changes were in the ≥85-year-old cohort, with endovascular procedures per capita increasing 188%; coinciding with both open LER and major LEA decreasing by 73% between 2001 and 2015. Australian hospital data between 2001 and 2015 shows that endovascular LER interventions and minor LEA have significantly increased per capita in Australians ≥45 years. In contrast, both open LER and major LEA rates have significantly decreased in the same cohort.