title: Sub-specialisation in neurosurgery: perspective from a small specialty.
abstract: BACKGROUND
  There is an increasing tendency towards sub-specialisation in the larger surgical specialties. The feasibility and effectiveness of this is less clear in the smaller specialties with limited manpower such as neurosurgery.
  
  
  METHODS
  To evaluate this, we carried out an audit comparing the throughput and outcome of patients treated for intracranial aneurysms in our unit before and after a period of neurovascular sub-specialisation.
  
  
  RESULTS
  In the period before sub-specialisation, 68 aneurysms were treated compared to 69 after sub-specialisation. The epidemiological profile of patients, their clinical condition at presentation and the location of aneurysms were not significantly different in the two periods. There was less morbidity and mortality and better long-term functional outcome (P = 0.05) following sub-specialisation. More investigations including cerebral angiograms were performed after sub-specialisation. The added cost, however, was offset against savings made by the shorter length of patient's hospital stay (P = 0.002).
  
  
  CONCLUSIONS
  Sub-specialisation appears to confer benefits both in terms of patient outcome and socio-economic gain.
authors.affiliation: Department of Neurosurgery, Hurstwood Park Neurological Centre, Haywards Heath, UK. kashkan@btinternet.com
authors.forename: Keyoumars
authors.initials: K
authors.lastname: Ashkan
authors.forename: Nicola
authors.initials: N
authors.lastname: Guy
authors.forename: John
authors.initials: J
authors.lastname: Norris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D004739:England; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007902:Length of Stay; D008485:Medical Audit; D008875:Middle Aged; D009493:Neurosurgery / Q000639:trends*; D019635:Neurosurgical Procedures / Q000592:standards*; D017063:Outcome Assessment, Health Care; D013038:Specialization / Q000639:trends*; D013345:Subarachnoid Hemorrhage / Q000601:surgery