A Surgeons Response Who When and Where Michael

A Surgeons Response - Who When and Where Michael Horrocks The Vascular Society

Sample Cases

Age Distribution

Age and Gender

Imaging Facilities ? Facilities in Remote Units

Out of Hours Imaging Lack of all Facilities in All Units

On-call Inerventional Rota by Unit Size

Organisation of Vascular. Services-1

Types of Unit ? Definitions

Elective and Emergency Repairs ? Large Units with Small Numbers

Ratio of Elective to Emergency Surgery

Relationship between Hospital Volume and Elective Outcome

On-call Vascular Rota

Outcome of Ruptures by Rota

Outcome of Emergencies by Hospital Volume

Outcome of Elective Repair by Unit Size

Outcome of Emergency Repair by Unit Size

Outcome of AAA Repair by Experience of Anaesthetist

Decision NOT to Operate by Unit

Influenceof Transfer

Age and Mortality

Surgical Delay

Length of Operation

Other Procedures

Grade of Most Senior Operating Surgeon

Number of Elective AAA Repair by Most Senior Surgeon

Time of Operaton and Outcome

Duration of Operation and Outcome

Organisation of Vascular. Services-1

Organisation of Vascular. Services-2

Organisation of Vascular. Services-3

Recommendation - 1

Recommendation - 2

Further Proposals • All vascular patients should be cared for only by appropriately trained vascular specialists in an appropriate setting • All vascular patients requiring surgery should be looked after by an experienced vascular anaesthetist • All this may require centralisation of Vascular Services with reshaping of the service • We should consider adopting Vascular Centres as proposed by the UEMS working party