Vascular surgeons - do they make a difference in peripheral vascular disease?

Background. The purpose of this study was to quantitate the effect of surge ons with added qualifications in general vascular surgery on aortic and per ipheral vascular surgery performed in a community hospital. Methods. We performed a retrospective study covering a 22-year period and c omparing indications, procedures,and results of surgeons who had added qual ifications in general vascular surgery with those of board certified genera l and thoracic surgeons in a private hospital. In Period I (1975-1982), the r were 702 vascular procedures all per formed by thoracic (65%) and general (35%) surgeons. In Period II (1982-1997), there were 2590 vascular procedu res performed by vascular surgeons (73%), general surgeons (7%), and thorac ic surgeons (20%). A further comparison was done to examine the results of surgeons with added qualifications in general vascular surgery with board c ertified general and thoracic surgeons within Period II. Results. The volume and frequency of different types of vascular surgery ch anged significantly from Period I to Period II with lower extremity prosthe tic reconstructions decreasing from 12% to 8.2% and autogenous lower extrem ity bypasses increasing from 15% to 36%. The percentage of distal reconstru ctions increased significantly from 27% of the total vascular surgeries in Period I to 44.3% in Period II. In Period II, vascular surgeons operated on older patients, had decreased mortality, decreased length of stay, and per formed more distal bypasses than board certified general and thoracic surge ons. Conclusions. The development of vascular surgery and a separate specialty a ppears to have had a beneficial effect on the types of vascular surgery and the results when compared in a contemporaneous or retrospective fashion.