Ten-year audit of arterial surgery from a district hospital.

An audit of 10 years of arterial surgery was undertaken to compare the first 5 years with the second 5 years. The aim was to see if the surgery during the second 5 years was being undertaken to an acceptable standard, and if there had been improvements in haemorrhagic complications and outcome for femoro-crural bypass grafts, which had previously been identified as problem areas during the first 5 years. Between the two 5-year periods, combined general surgical and arterial admissions and operations reduced by 21.8% and 26.2%, respectively, owing to marked reductions in gastrointestinal and biliary patients. At the same time, arterial admissions and operations increased by 55.7% and 46.6%, respectively. Improvements were found in outcome for aortic and iliac aneurysms and lower limb bypasses, in particular crural grafts. Aorto-iliac and aortofemoral bypasses were undertaken less frequently with a higher mortality and more complications, but in the second 5 years these patients were more urgent and more likely to have a threatened limb. There was a reduction in re-operation for postoperative bleeding in the second 5 years (4.6% vs 2.2%). It was concluded that the surgery was being undertaken to an acceptable standard, but that the quantity of vascular surgery during the second 5 years was such that continued single-surgeon practice in the present setting was unacceptable.