Huge Disparity in Death Rates between NHS Hospitals for Vascular Surgery
The Guardian has reported the results of its investigation into the outcomes of planned vascular surgery, after making extensive freedom of information requests. These were necessary as information on death rates is not readily available. Death rates for planned vascular surgery for an abdominal aortic aneurysm (AAA), an operation carried out to prevent a burst artery, vary between hospital units from under 0% to a staggering 28.6%. The national average death rate is just over 4%. More than 5,000 of the operations are carried out each year. The figures clearly point towards lower death rates at bigger, busier hospital units, where the surgical teams are more skilled as they do more of these procedures. Should smaller units continue to offer these operations?
Aware of the problem, Healthcare for London commissioned a major re-structuring programme before the election to stop vascular surgery in hospital clinics that only have a few cases a year. However, Andrew Lansley, the Health Secretary has recently stopped all hospital reorganization. This is as a result of his election promise to stop hospital closures. Many surgeons believe that hospitals doing less than 50 AAA operations a year should not be doing them, and that allowing smaller clinics to continue to perform these operations is risking lives unnecessarily. Yet many hospitals across the country see less than 20 cases per year. Dartford and Gravesham had just five in three years, Mid Staffordshire had nine and Scarborough had 14.
The hospital unit with the highest death rate was the Scarborough Hospital in Yorkshire, where they stopped offering the operation last year, because of the high death rates.
These results also show that UK hospitals are falling behind results in the rest of Europe. The second Vascunet report, measuring vascular surgery across ten European countries in 2008, found that the average death rate was 2.8%.
Worryingly, the information obtained through the freedom of information requests did not match the information provided to the public on the NHS Choices website. For example, despite the death rate at the Scarborough Hospital being far higher than the national average, the NHS Choices website gave the survival rate for these operations at the hospital to be ‘as expected’. Further, three hospital trusts did not provide any information, and four trusts ignored the requests altogether.
These findings highlight several areas that need consideration; the responsibility taken by hospitals and individual surgeons for their performances, the availability and accuracy of these statistics to the public, to allow patients to make an informed decision about their treatment provider, and clearly the death rates themselves, and why they are higher than the European average. This appears to be because we are not concentrating on providing these operations in specialist clinics, with surgeons who are experienced in this procedure, and carrying them out on a regular basis.
Another instance of a postcode lottery. I hope that the evidence in support of a re-organisation of hospital resources in this area means that changes are made, and saving lives is put ahead of Andrew Lansley’s wish to halt change.
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