Anaesthetic specialisation leads to improved early- and medium-term survival following major vascular surgery.
OBJECTIVE
Vascular surgical specialisation is associated with improved outcomes. We aimed to assess the effect of anaesthetic specialisation on outcome following major vascular surgery.


METHODS
Retrospective cohort study.


METHODS
Patients undergoing major vascular surgery (lower limb revascularisation, elective and ruptured abdominal aortic aneurysm repair, endovascular aneurysm repair and carotid endarterectomy) over a five-year period were identified from a prospective database. The primary outcomes were death within 30 days and death within two years of surgery. Potential risk factors for mortality were assessed using multivariate logistic regression modelling.


RESULTS
The analysis cohort comprised 1155 patients followed up for a median of 583 days. Mortality within two years of surgery was 16%. For the overall cohort, care from vascular anaesthetists was independently associated with reduced 30-day (odds ratio 0.22; 95% CI 0.12-0.62) and medium-term mortality (0.31; 95% CI 0.18-0.55). For elective patients (n=851), vascular anaesthesia reduced two-year mortality (odds ratio 0.29; 95% CI 0.15-0.58; P=0.0004) though not 30-day mortality (odds ratio 0.55; 95% CI 0.15-1.95; P=0.35). For emergency patients, care by a vascular anaesthetist influenced neither 30-day mortality (odds ratio 0.33; 95% CI 0.08-1.41; P=0.13) nor medium-term mortality (odds ratio 0.45; 95% CI 0.17-1.21; P=0.11).


CONCLUSIONS
Anaesthetic specialisation reduced early- and medium-term mortality rates following major vascular surgery. If replicated by prospective studies, these results suggest that vascular surgery services would benefit from specialised anaesthetic support.
Walsh
S R
SR
Norfolk & Norwich Vascular Unit, Norfolk & Norwich University Hospital, Colney lane, Norwich NR4 7UY, United Kingdom. srwalsh@doctors.org.uk
Bhutta
H
H
Tang
T Y
TY
Nunn
D L
DL
Armon
M P
MP
Clarke
J M F
JM
Meyer
F J
FJ
D000368:Aged; D000758:Anesthesia / Q000592:standards*; D000776:Anesthesiology / Q000193:education*; D016001:Confidence Intervals; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014652:Vascular Diseases / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000401:mortality*