Changes in the provision of vascular surgery in a single health region over 10 years

This study examines changes in vascular service provision and activity in a single UK health region over 10 years.

A questionnaire on involvement in vascular surgery was sent to all general surgeons in the Oxford region in 1992, 1997 and 2001. Data on involvement in vascular surgery were obtained from the Department of Health.

Over 10 years the number of general surgeons not performing any emergency vascular (arterial) surgery rose from 33% to 65% (P = 0.002). There was also a fall in the number of general surgeons performing only emergency vascular surgery (P = 0.009). Trends were observed towards more vascular emergencies being transferred to another hospital (P = 0.068) and proportionally fewer general surgeons undertaking recurrent varicose vein surgery (P = 0.09). The number of vascular reconstructions was 20.8 per 100,000 population in 1990-1991, rising to 32.3 per 100,000 in 1997-1998 but falling to 27.2 per 100,000 by 1999-2000, the greatest increase in activity was seen in the regional centre. Endovascular procedures increased from 8.2 per 100,000 in 1990-1991 to 21.27 in 1995-1996 falling to 17.4 by 1999-2000. In the regional centre there was a fall of 57% in such procedures from 1996-1997 to 1999-2000. Over 10 years, the overall major amputation rate remained between 10-12 per 100,000.

The changes reflect the gradual separation of vascular surgery from general surgery occurring nationally. They also suggest a more conservative approach in the management of certain vascular conditions.