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Patient outcome alone does not justify the centralisation of vascular services.

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.