A review of amputation and revascularisation rates in a small European state

Abstract

Background: Until 2007 vascular services in Malta were provided by general surgeons with a vascular interest. In late 2007 a vascular specialist was recruited to contribute to the service. This catered for a gradual transfer of services to a pure vascular specialist service in 2014. The aim was to assess the impact of the introduction of vascular specialist services on lower limb major and minor amputation rates and open revascularisation procedures in Malta. Methodsː This is a retrospective analysis of prospectively collected data. Data from the Hospital annual surgical operation reports and the Vascular Database was analysed between 2002 and 2014. Data was analysed by time period (Period 1: 2002-2007 – no vascular specialist service; Period 2: 2008-2013 - partial vascular specialist service; Period 3 – January to December 2014 complete vascular specialist service). Resultsː There was a significant drop in the average rate of major amputations/year between Period 1 and Period 2 (120 vs 96; p=0.008) and between Period 1 and Period 3 (120 vs 64; p<0.001). A significant increase in minor amputations/year between period 1 and period 2 (102 vs 242; p<0.001) and between period 1 and period 3 (102 vs 449; p<0.001) was noted. There was significant increase in open revascularisation rates between period 1 and period 2 (21.5 vs 73.2; p<0.001) and between period 1 and period 3 (21.5 vs 144; p<0.001). Conclusionː The employment of vascular specialists can lead to a significant increase in lower limb open revascularisation rates and a concomitant significant reduction in lower limb major amputation rates.