Interventional radiology emergency service provision for a large UK urban population: initial 3.5 years of experience

To review the activity and impact of an out-of-hours (OOH) interventional radiology service introduced in Glasgow in 2007.

A retrospective review of the first 42 months formal OOH activity across 11 hospital sites covering a population of 1.2 million was undertaken. The 30 day mortality and cause of death was logged for each procedural subtype [nephrostomy, biliary and abscess drainage, enteric stenting, transjugular intrahepatic porto-systemic shunt (TIPS), thoracic endovascular aortic aneurysm repair (TEVAR), endovascular, and embolization].

From October 2007 to March 2011, 502 cases were identified. The mean number of procedures performed per month was 12 (range 5-21). This represents an event rate of 12/100,000 population/year. A minority (11%) of cases were undertaken after midnight. The activity levels were stable over the 42 month study period. The most frequent procedures were percutaneous nephrostomy (32%) and embolization for haemorrhage (30%). Thirty-day mortality was 17% for the entire group but varied from 53% (biliary intervention) to 0% (TEVAR). There was no death following embolization for obstetric haemorrhage. Approximately half of the deaths were due to a failure of the procedure to control the underlying clinical problem.

The demand for OOH services is important but not unduly onerous. There is no evidence of expansion of demand after launching such a service. Mortality rates probably reflect the underlying clinical status of this emergency patient group. Certain procedures carry a high mortality rate, raising issues of clinical judgement, appropriateness of intervention, and/or timing.