Falling incidence of amputations for peripheral occlusive arterial disease in Western Australia between 1980 and 1992

Objectives:To assess temporal trends in the incidence of surgical procedures for peripheral occlusive arterial disease (POAD) and associated changes in outcome as measured by the rate of major lower limb amputations for POAD.Design:A retrospective descriptive population-based study was conducted of the geographically isolated population of Western Australia between 1980 and 1992.Methods:Vascular procedures with an accompanying diagnosis of POAD were identified in a computerised system of name-identified records of all discharges from hospital for the population. These procedures were detected using relevant codes from the International Classification of Diseases and Procedures. Records of angioplasty and thrombolysis procedures were augmented by searches of hospital-based registers of invasive radiological procedures. The data for the remaining procedures were validated by a review of a random sample of medical records.Results:Over the 13 years of the study, rates of major amputations fell significantly for women under 70 years of age and for men under 80 years from 1983. At the same time there was a significant fall in non-amputation vascular surgery for individuals under the age of 60. In addition, rather than an overall rise in surgery there was shift away from sympathectomy and thromboendarterectomy to angioplasty and bypass surgery. Furthermore, an increasing proportion of all major amputations had a prior attempt at arterial reconstruction.Conclusion:These observations suggest the decrease in major amputations for POAD may reflect a fall in the incidence of POAD, possibly aided by more effective surgery, rather than increased rates of vascular surgery