The importance of vascular surgical audit to surgeons, patients and purchasers.

This audit of vascular surgical operations from a Teaching Hospital vascular unit was facilitated by computerised data collection. A total of 2075 patients had 2628 procedures over the 6-year period 1985-1990. Vascular workload increased by 50% to almost 350 primary reconstructions per year. In Bristol, vascular patients now occupy 19% of surgical bed-days. Mean stay for vascular patients is twice as long as for general surgical patients (14 days vs. 6 days) and three times as long for patients having secondary reconstructions (18 days) or those with critical limb ischaemia (21 days). Mortality and reoperation rates remained relatively constant throughout the study period. The overall mortality rate was 10.4%, being highest for ruptured aortic aneurysms (31.9%) and lowest for carotid endarterectomy (1.7%). Early reoperation for the complications of vascular reconstruction was required in 9.1% cases, being most frequent for femoro-tibial grafts (26.1%) and least for carotid endarterectomy (1.7%). Vascular surgery is expensive, time consuming and on the increase in Bristol. Comprehensive computerised audit of vascular operating is essential both for patients who benefit from the maintenance of high standards, and also for surgeons whose results this year will determine the cost and volume of next year's contracts.