Vascular surgery in a small community hospital: review of 286 consecutive major procedures.

From August 1981 to August 1985, 286 major vascular procedures were performed in a small community hospital by one trained vascular surgeon. The procedures were performed in 272 patients, 174 (64%) of whom were men and 98 (36%) of whom were women, with a median age of 66.3 years. The average length of hospital stay was 9.3 days. Two hundred fifty-three (88%) of the cases were elective, and the other 33 (12%) were emergencies. The overall operative mortality was 1.9% (5 out of 253 patients) in the elective group and 27.0% (9 out of 33 patients) in the emergency group. The stroke and mortality rate was 1.2% for elective cerebrovascular procedures. Sixty infrainguinal bypasses were performed, with three early failures and one late failure resulting in major amputation. All failures occurred in the limb salvage group (who had infrapopliteal bypasses and profundoplasty). These data suggest that vascular surgery can be performed safely and adequately in a small community hospital, with results comparable to those of a university hospital, and that vascular surgeons may maintain an adequate level of competence even if they perform fewer than 100 cases per year.