title: Regional differences in the use of a vascular surgical service and incidence of amputations in a well-defined geographical area.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  One university and five county hospitals, Finland.
  
  
  METHODS
  All referrals to the university hospital vascular surgical unit for chronic critical lower limb ischaemia and the number of major amputations in the region.
  
  
  METHODS
  Numbers of new vascular surgical consultations and amputations in 11 municipalities. Correlation between numbers of consultations and amputations.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  An active referral policy leads to reduced amputation rates.
authors.affiliation: Department of Surgery, University Hospital, Medical School, Tampere, Finland. mheik@netti.fi
authors.forename: Maarit A
authors.initials: MA
authors.lastname: Heikkinen
authors.forename: Juha P
authors.initials: JP
authors.lastname: Salenius
authors.forename: Jukka P
authors.initials: JP
authors.lastname: Saarinen
authors.forename: Jari
authors.initials: J
authors.lastname: Laurikka
authors.forename: Riina
authors.initials: R
authors.lastname: Metsänoja
authors.forename: Rainer
authors.initials: R
authors.lastname: Zeitlin
authors.forename: Velipekka
authors.initials: V
authors.lastname: Suominen
authors.forename: Ossi
authors.initials: O
authors.lastname: Auvinen
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D035002:Lower Extremity; D008297:Male; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011336:Probability; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014505:Urban Population; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*