The Need of Preventing Smoking and Tobacco Abuse Related Amputations in Bosnia and Herzegovina

Last data from 2005 shows that Bosnia and Herzegovina has 37.6 % current smokers between 18-65 years. 29.7% of them are female and 49.2 % male. In the region of Sarajevo 13.8% pupils are active smokers (16.8% boys, and 10% girls). We have evaluated smoking impact on patients in Clinical Center Sarajevo treated for occlusive arterial disease who had finished their treatment with amputation after exhausting efforts of vascular surgery and angiological therapy measures. Evaluation covers period of ten years (from 1998 to 2007) and patients treated in Vascular Surgery Department and Orthopaedic and Traumatology Department. Average age of patients was 56 year. The youngest patient was 22 and the oldest was 88 year. 70.3% of total number (990 patients) were smokers. From total number of 387 above knee amputations, 159 was done in diabetic patients - smokers which means 41.08%, or 16.06% of total number of amputations. 699 (70.6%) smoking patients underwent major amputation operations (above and below knee amputations). Only 63 patients (6.36%) without major risk factors (smoking and diabetes) had amputation as a final result of treatment. In 52 (5.25%) patients with major or other amputations we have found obliterative thromboangiitis (Buerger’s disease). In 23 patients (2.32%) with amputation we have found other inflammatory thrombotic diseases. In some cases amputation was done as urgent measure in which surgeons had no time for details in diagnostic evaluation. Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun.