Vascular 03

Abstract

Over the course of the past decade, numerous changes have occurred in the management of patients undergoing vascular surgery operations. The introduction of high dependency units (HDUs) has meant that many patients previously requiring observation in intensive care units (ICUs) are now managed in this new environment. This study reports the chronological changes in resource utilization of patients undergoing major vascular surgery at a district general hospital (DGH). Details of all patients admitted to either the ICU or HDU under the care of a single vascular surgeon during the period 1991–2000 were extracted from the prospectively maintained departmental database. Details of the age and sex of patients were obtained together with source of admission, place of discharge and duration of stay. Operative details for each patient were extracted from a prospectively maintained vascular surgery database. Details of patients not attending either HDU or ICU during the postoperative phase were obtained from the same source. During the 10-year period under study, numerous changes in vascular surgery practice were observed. The HDU unit was opened in 1992. Subspecialization over the past decade has meant a significantly increased major vascular workload. Since the introduction of the HDU, there has been a significant fall in the use of ICU facilities for routine cases. These changes in resource utilization have significant implications in terms of budget allocation. It would appear that finances, in relation to vascular surgery, should be concentrated on expanding HDU facilities and ensuring vascular surgery expertise amongst ward nursing staff.