title: Model for the reconfiguration of specialized vascular services.
abstract: BACKGROUND
  This article built on previous work to develop an algorithm for elective abdominal aortic aneurysm (AAA) repair and carotid endarterectomy (CEA), with the aim of improving patient survival by regionalization of services. Vascular procedures were used as an example of specialized surgical services.
  
  
  METHODS
  A model was generated based on a national data set that incorporated the statistical demonstration of procedural safety, hospital annual surgical case volume, and travel distance and time. Elective AAA repair was used to construct a hub-and-spoke model that was tested against CEA. The impact of the model was quantified in terms of mortality rates, and travel distance and time.
  
  
  RESULTS
  Only 48 vascular hubs were required to provide adequate coverage in England, with the majority of patients travelling for less than 1 h to access inpatient vascular surgery. The model predicted a reduction in the number of deaths from elective surgery for AAA (P < 0.001) and CEA (P = 0.016).
  
  
  CONCLUSIONS
  Adoption of this strategic model may lead to improved outcome after AAA and CEA. It could be used as a model for the regionalization of specialized surgery. The model does not take into account the complexity of providing a comprehensive vascular service in every locality.
authors.affiliation: St. George's Vascular Institute, St. George's Hospital, St. George's University of London, London, UK. peteholt@btinternet.com
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
authors.forename: J D
authors.initials: JD
authors.lastname: Poloniecki
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D003695:Delivery of Health Care; D016894:Endarterectomy, Carotid / Q000401:mortality*; D004739:England; D006801:Humans; D017146:Models, Organizational; D018570:Risk Assessment; D017751:Safety Management; D014187:Transportation of Patients; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000458:organization & administration*