Declining incidence of amputation for XXXX in Scotland.

@entity1 @entity455
OBJECTIVES: To determine time trends and geographical variations in the incidence of major amputation for peripheral @entity455 and whether lower rates of amputation were related to higher rates of arterial reconstruction. DESIGN: Analysis of Scottish hospital discharge data. SETTING: Scotland 1981-1990. MATERIALS: @entity1 undergoing major amputation or arterial reconstruction for peripheral @entity455 . CHIEF OUTCOME MEASURES: Time trends in age-sex standardised rates of major amputation and arterial reconstruction, and correlation between the rates of these operations by health board. MAIN 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 @entity1 but a paradoxical increase was observed in @entity1 . 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.
