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 pro cedures for peripheral occlusive arterial disease (POAD) and associate d changes in outcome as measured by the rate of major lower limb amput ations for POAD. Design: a retrospective descriptive population-based study was conducted of the geographically isolated population of Weste rn Austrialia between 1980 and 1992. Methods: Vascular procedures with an accompanying diagnosis of POAD were identified in a computerised s ystem of name-identified records of all discharges from hospital for t he population. These procedures were detected using relevant codes fro m the International Classification of Disease and Procedures. Records of angioplasty and thrombolysis procedures were augmented by searches of hospital-based registers of invasive radiological procedures. The d ata for the remaining procedures were validated by a review of a rando m sample of medical records. Results: over the 13 years of the study, rates of major amputations fell significantly for in non-amputation va scular surgery for individuals under the age of 60. In addition, rathe r than an overall rise in surgery there was shift away from sympathect omy and thromboendarterectomy to angioplasty and bypass surgery. Furth ermore, an increasing proportion of all major amputations had a prior attempt at arterial reconstruction. Conclusion: These observations sug gest the decrease in major amputations for POAD may reflect a fall in the incidence of POAD, possibly aided by move effective surgery, rathe r than increased rates of vascular surgery.