Which deaths in vascular surgery are avoidable? A review of 150 consecutive deaths occurring on the Oxford regional vascular service.

One hundred and fifty consecutive deaths occurring on the Oxford regional vascular service were reviewed using data collected prospectively by weekly audit to determine which deaths were avoidable. During the period of study there were 2449 admissions to the vascular service and 1796 operations were performed. Of those who died 71 (47%) had aneurysmal disease and 76 (51%) occlusive disease. Most were elderly (89% were over 65 years) and died from their presenting disorder or associated conditions. Thirty-four deaths were considered to have been avoidable and were caused or hastened by errors in management. Twenty-one of these occurred in patients with a ruptured abdominal aortic aneurysm. In eleven cases delayed diagnosis (7) or inter hospital transfer (4) were implicated. Eighteen deaths were associated with surgical and three with anaesthetic errors which would have been undetected but for the weekly audit. Our experience suggests that while early diagnosis of ruptured abdominal aortic aneurysm and rapid transportation to a specialist vascular service would save some lives, technical management errors remain the major cause of avoidable deaths in vascular surgery.