Restructuring of the UK Vascular Services: does the hub versus spoke model affect patient mortality in ruptured abdominal aortic aneurysms?

Abstract

Background: Ruptured abdominal aortic aneurysms (AAA) are a frequently fatal vascular condition. The centralisation of vascular services in the UK was driven by the positive volume–outcome relationship witnessed within vascular surgery and other major surgical specialities. In 2018, The Get It Right First Time (GIRFT) programme officially recommended the restructuring of vascular services in England to a hub and spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region. Methods: We conducted a retrospective review from 1 January 2017 to 31 December 2020, identifying 110 patients with a ruptured AAA presenting to hub and spoke sites. We determined if there was any association between mortality and the presenting site. Results: Forty-one patients presented to the hub site (Royal Liverpool University Hospital) and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in Accident and Emergency or were palliated. 57% of those who underwent an intervention survived. The overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p=0.585). Conclusion: This study is concordant with further published data supporting the centralisation of services for ruptured AAA.