Current differences in referral patterns for pulmonary endarterectomy in the UK.

Area of Science:

• Cardiology
• Thoracic Surgery
• Public Health

Background:

• Pulmonary endarterectomy (PEA) is the primary surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH).
• The UK has seven specialist centers, but provision is centralized at Papworth Hospital for PEA.
• This setup allows for studying national incidence and geographical distribution of operable CTEPH.

Purpose of the Study:

• To investigate the geographical distribution of PEA referrals across the UK.
• To identify potential disparities in access to this potentially curative surgery.

Main Methods:

• Analysis of 262 UK residents who underwent PEA surgery from April 2000 to May 2006.
• Comparison of age-adjusted cumulative referral rates between different UK regions.
• Statistical testing for uniformity of referral rates across regions.

Main Results:

• Significant geographical variation in PEA referral rates was observed across the UK.
• Referral rates were highest near specialist centers, particularly East Anglia and West Midlands (near Papworth).
• Observed rates in these regions deviated significantly ( >2 SD) from the national average.

Conclusions:

• Wide geographical disparities exist in patient referrals for pulmonary endarterectomy surgery.
• This variation indicates that some eligible patients may not be receiving this potentially curative treatment.
• Healthcare policy may need to address equitable access to PEA across all UK regions.