CASE-MIX AND OUTCOME OF PATIENTS REFERRED TO THE VASCULAR SERVICE AT A DISTRICT GENERAL-HOSPITAL

A prospective audit has been carried out to evaluate the trends in cas e mix and initial management of vascular surgical referrals to a singl e surgeon at a district general hospital. Over a 3-year period there w ere 1096 new emergency or routine referrals from a population of appro ximately 450 000. A total of 613 of these patients underwent vascular procedures, with a further 297 procedures subsequently being undertake n on the same patients during the period of the audit. There was a ste ady increase in the total number referred with little change in case m ix with regard to age or diagnosis. Elderly patients had more severe s ymptoms and were less likely to be treated by minimally invasive means . The number of patients undergoing angioplasty or thrombolysis increa sed steadily without any corresponding reduction in the number of surg ical procedures. It is concluded that there is a steady trend towards increasing vascular surgical workload which is not easily explained by a change in disease incidence or case mix. Elderly patients appear un likely to be referred unless symptoms are severe and there are few ref errals of elderly patients who might benefit from minimally invasive t reatments.