Declining incidence of amputation for arterial disease in Scotland.
OBJECTIVE
To determine time trends and geographical variations in the incidence of major amputation for peripheral arterial disease and whether lower rates of amputation were related to higher rates of arterial reconstruction.


METHODS
Analysis of Scottish hospital discharge data.


METHODS
Scotland 1981-1990.


METHODS
Patients undergoing major amputation or arterial reconstruction for peripheral arterial disease.


METHODS
Time trends in age-sex standardised rates of major amputation and arterial reconstruction, and correlation between the rates of these operations by health board.


RESULTS
In Scotland, between 1981 and 1990, the incidence of major amputation fell by 22% (p < 0.001). Inconsistencies were observed within different age-sex groups. In the population under 65 years of age the incidence of amputation fell by 45% (p < 0.001), whereas in those over 65 years the incidence increased by 54% (p < 0.001). Amputation rates fell in men but a paradoxical increase was observed in women. Between 1981 and 1990, rates of arterial reconstruction doubled (p < 0.001), with an increase in all age-sex groups. Rates of amputation and reconstruction varied between health boards of residence, with a positive correlation (r = 0.5) between rates of operations within health board. Therefore areas with higher reconstruction rates tended to have higher amputation rates.


CONCLUSIONS
In Scotland, the incidence of amputation has fallen during a period when reconstruction rates have risen greatly. However inconsistencies in time trends by age-sex groups, and the lack of an inverse correlation by health board of residence, suggest that fewer amputations are unlikely to be due solely to an increase in reconstructive surgery.
Pell
J P
JP
Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, U.K.
Fowkes
F G
FG
Ruckley
C V
CV
Clarke
J
J
Kendrick
S
S
Boyd
J H
JH
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005734:Gangrene / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology