Patient outcome alone does not justify the centralisation of vascular services

Background: The Provision of Vascular Services document from the Vascular S urgical Society of Great Britain and Ireland argues for the centralisation of vascular services into units served by a minimum of four vascular consul tants. The rationale for this is the presumed advantages of improved patien t care, better utilisation of resources and a more comprehensive arrangemen t of consultant vascular cover. Since April 1998, the Royal Surrey County H ospital (RSCH) has had a single-handed vascular consultant with out-of-hour s 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 amp utation between April and November 1998 were analysed. Results: 86 patients underwent 102 surgical procedures in 92 separate admis sions. Data retrieval was 100%. Predicted (E) mortality 16 cases; observed (O) mortality 13 cases; O:E ratio 0.80. Predicted morbidity 26 cases; obser ved 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-d istrict consultant cover, is equivalent to that found in a major vascular u nit. Centralisation of vascular services cannot be justified on the basis o f differences in patient outcome.