BACKGROUND: The Provision of Vascular Services document from the Vascular Surgical Society of Great Britain and Ireland argues for the centralisation of vascular services into units served by a minimum of four vascular consultants. The rationale for this is the presumed advantages of improved patient care, better utilisation of resources and a more comprehensive arrangement of consultant vascular cover. Since April 1998, the Royal Surrey County Hospital (RSCH) has had a single-handed vascular consultant with out-of-hours cross-district consultant vascular cover. OBJECTIVES: To use P-POSSUM analysis to determine patient outcome from the RSCH vascular unit, and to compare these with previously published P-POSSUM analysis from a major vascular unit in Leeds. PATIENTS AND METHODS: All patients undergoing major vascular surgery or amputation between April and November 1998 were analysed. RESULTS: 86 patients underwent 102 surgical procedures in 92 separate admissions. Data retrieval was 100%. Predicted (E) mortality 16 cases; observed (O) mortality 13 cases; O:E ratio 0.80. Predicted morbidity 26 cases; observed morbidity 19; O:E ratio 0.73. O:E ratio for mortality from Leeds = 0.83. CONCLUSIONS: Patient outcome in a single-handed vascular unit, with cross-district consultant cover, is equivalent to that found in a major vascular unit. Centralisation of vascular services cannot be justified on the basis of differences in patient outcome.
BACKGROUND: The Provision of Vascular Services document from the Vascular Surgical Society of Great Britain and Ireland argues for the centralisation of vascular services into units served by a minimum of four vascular consultants. The rationale for this is the presumed advantages of improved patient care, better utilisation of resources and a more comprehensive arrangement of consultant vascular cover. Since April 1998, the Royal Surrey County Hospital (RSCH) has had a single-handed vascular consultant with out-of-hours cross-district consultant vascular cover. OBJECTIVES: To use P-POSSUM analysis to determine patient outcome from the RSCH vascular unit, and to compare these with previously published P-POSSUM analysis from a major vascular unit in Leeds. PATIENTS AND METHODS: All patients undergoing major vascular surgery or amputation between April and November 1998 were analysed. RESULTS: 86 patients underwent 102 surgical procedures in 92 separate admissions. Data retrieval was 100%. Predicted (E) mortality 16 cases; observed (O) mortality 13 cases; O:E ratio 0.80. Predicted morbidity 26 cases; observed morbidity 19; O:E ratio 0.73. O:E ratio for mortality from Leeds = 0.83. CONCLUSIONS:Patient outcome in a single-handed vascular unit, with cross-district consultant cover, is equivalent to that found in a major vascular unit. Centralisation of vascular services cannot be justified on the basis of differences in patient outcome.