title: Vascular surgery within general surgery: an analysis of workload 1989-2005.
abstract: BACKGROUND
  There is considerable debate as to whether vascular surgery should be a subspecialty separate from general surgery. This study examines the changing relationship between general and vascular surgery in a district general surgical unit over 16 years.
  
  
  METHODS
  A detailed survey of referrals, admissions and operations to one unit was carried out over 3 months in 2003. This was compared with similar surveys in 1989, 1990 and 1995. In addition a 3-month audit of operations performed was carried out in 2005 following a decision by the Primary Care Trust (PCT) to reduce varicose vein referrals.
  
  
  RESULTS
  There was a significant increase in the number of varicose vein and arterial referrals 1989-2003 (P = 0.0001 and P < 0.0001, respectively). This was reflected in increased number of vascular admissions (P < 0.0001). In 1989, 14% of the arterial cases were admitted as emergencies. This figure rose to 52% in 2003 (P < 0.0001). There was a significant increase in the number of arterial operations performed between 1989 and 1995; however, from 1995 to 2003 this number fell P < 0.0001). The number of varicose vein procedures increased significantly 1989-2003 (P < 0.0001), with a significant fall after the PCT decision (P < 0.0001). However, the number of operations carried out in 2005 increased slightly with the proportion of general surgical cases, mostly hernia repairs and laparoscopic cholecystectomies, increasing.
  
  
  CONCLUSIONS
  With increasing specialisation comes the risk that reduction in any aspect of a particular specialty may result in that unit becoming unsustainable. In vascular surgery this will inevitably lead to centralisation of services. In a large district general hospital having two general surgeons with a vascular interest, the general surgical component has maintained the workload of the unit following reduction in varicose vein referrals.
authors.affiliation: Department of Surgery, Royal Berkshire Hospital, Reading, UK.
authors.forename: S Q
authors.initials: SQ
authors.lastname: Ashraf
authors.forename: A
authors.initials: A
authors.lastname: Bajwa
authors.forename: T R
authors.initials: TR
authors.lastname: Magee
authors.forename: R B
authors.initials: RB
authors.lastname: Galland
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D004739:England; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*