Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, how many limb amputations were undertaken in the Plymouth area in each of the last five years; and how many such operations were as a result of (a) smoking and (b) diabetes.

The information is not available in the format requested. Such information as is available is in the following table.

Count of finished consultant episodes (FCEs) with (a) a main or secondary procedure of amputation and (b) a primary diagnosis of diabetes and a main or secondary procedure of amputation by the selected hospital provider for the years 2009-10 to 2013-14.

Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre

Notes

1. Finished Consultant Episode (FCE)

A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year.

2. Number of episodes with a main or secondary procedure

The number of episodes where the procedure (or intervention) was recorded in any of the 24 (12 from 2002-03 to 2006-07 and 4 prior to 2002-03) procedure fields in a HES record. A record is only included once in each count, even if the procedure is recorded in more than one procedure field of the record. Note that more procedures are carried out than episodes with a main or secondary procedure. For example, patients undergoing a ‘cataract operation’ would tend to have at least two procedures – removal of the faulty lens and the fitting of a new one – counted in a single episode.

3. OPCS codes for amputation procedure

The following OPCS codes were used to define amputation:

X07 - Amputation of arm

X08 - Amputation of hand

X09 - Amputation of leg

X10 - Amputation of foot

X11 - Amputation of toe

X121 – Re-amputation at higher level

One of the following site codes must be assigned in a secondary position to X12.1 in order to identify an amputation:

Z68 - Bone of shoulder girdle

Z69 - Humerus

Z70 - Radius

Z71 - Ulna

Z72 - Other bone of arm or wrist

Z73 - Other bone of hand

Z76 - Femur

Z77 - Tibia

Z78 – Other bone of lower leg

Z79 - Bone of tarsus

Z80 - Other bone of foot

4. Primary diagnosis

The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) diagnosis fields in the HES data set and provides the main reason why the patient was admitted to hospital.

5. ICD-10 diagnosis codes for diabetes

The following ICD-10 codes were used to identify diabetes:

E10 - Insulin-dependent diabetes mellitus

E11 - Non-insulin-dependent diabetes mellitus

E12 - Malnutrition-related diabetes mellitus

E13 - Other specified diabetes mellitus

E14 - Unspecified diabetes Mellitus

6. Hospital Provider

A provider code is a unique code that identifies an organisation acting as a health care provider (e.g. NHS trust). Data from some independent sector providers, where the onus for arrangement of data flows is on the commissioner, may be missing. Care must be taken when using these data as the counts may be lower than true figures.

7) Assessing growth through time (Admitted patient care)

HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.

Note that HES include activity ending in the year in question and run from April to March, e.g. 2012-13 includes activity ending between 1 April 2012 and 31 March 2013.