Case mix and outcome of patients referred to the vascular service at a district general hospital.

A prospective audit has been carried out to evaluate the trends in case mix and initial management of vascular surgical referrals to a single surgeon at a district general hospital. Over a 3-year period there were 1096 new emergency or routine referrals from a population of approximately 450,000. A total of 613 of these patients underwent vascular procedures, with a further 297 procedures subsequently being undertaken on the same patients during the period of the audit. There was a steady increase in the total number referred with little change in case mix with regard to age or diagnosis. Elderly patients had more severe symptoms and were less likely to be treated by minimally invasive means. The number of patients undergoing angioplasty or thrombolysis increased steadily without any corresponding reduction in the number of surgical procedures. It is concluded that there is a steady trend towards increasing vascular surgical workload which is not easily explained by a change in disease incidence or case mix. Elderly patients appear unlikely to be referred unless symptoms are severe and there are few referrals of elderly patients who might benefit from minimally invasive treatments.