Workload in a provincial New Zealand vascular surgery service

There is increasing evidence that centralising complex surgical procedures improves mortality rates. The focus on mortality as the primary outcome measure overlooks every other aspect of a local surgical service that could be lost by centralisation. The aim of this audit was to assess the total vascular service provided in a provincial vascular surgical unit

This was a 12-month prospective audit of the vascular surgical service in Taranaki. All outpatient and inpatient vascular consultations and procedures carried out by a surgeon or interventional radiologist were identified.

There were 181 inpatient admissions of which 121 (67%) were elective and 60 (33%) acute. There were 41 (29%) non-operative admissions, while 140 (71%) required an operation as an inpatient. There were 967 total bed days for vascular patients with an average stay of 5 days (4-6 95% CI). There were 588 vascular outpatient consultations for 396 patients. There were 201 (34%) new patient visits and 387 (66%) follow up appointments.

Although the number of operations performed per population per year in Taranaki over the audit period was consistent with other reports, the number of major vascular cases did not meet suggested annual thresholds for minimising mortality. Despite this there was no evidence of increased mortality in any group. There was a large amount of non operative work which is not considered when focus is exclusively on mortality.