2015 NVR Annual Report

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More patients survive abdominal arterial surgery but waiting times vary across the country

Survival rates have increased for patients undergoing a planned operation to treat a potentially fatal condition, due to improvements in the delivery of vascular surgery in the NHS, a national audit of vascular surgery has found.

Abdominal aortic aneurysm (AAA) is a life-threatening, but often symptom-free condition. It occurs when a bulge forms in the main blood vessel – the aorta – leading from the heart to the lower half of the body. The disease typically affects the aorta below the kidneys, and is most common in those aged over 65 years and among men. If this bulge ruptures, it causes catastrophic internal bleeding.

Among the 12,000 patients who had an elective, or planned, operation to repair an aneurysm between 2012 and 2014, the proportion who died in hospital after surgery was 1.5%. By comparison, between 2010 and 2012, 2.4% of patients died following surgery to repair an aneurysm.

However, there are still significant variations in waiting times for patients in different parts of the country. The risk of a rupture is very small and is best managed by preventing the time from a patient being assessed to receiving surgery, from becoming too long.

In 2014, the time that patients waited from their pre-surgery assessment to their operation was typically between 60 and 90 days. However, at 38 of the 81 NHS hospitals that perform these surgical repairs, a quarter of patients waited more than 120 days. The Vascular Society recommends that NHS hospitals should aim to reduce these longer waiting times.

These are the findings of the 2015 Annual Report of the National Vascular Registry, commissioned by the Healthcare Quality Improvement Partnership (HQIP)* as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and carried out by the Royal College of Surgeons of England and the Vascular Society of Great Britain and Ireland.

Prof Ian Loftus, Chair of the Audit Committee of the Vascular Society, said:

“This report shows a significant improvement in outcomes for patients having planned surgery for abdominal aortic aneurysm over a relatively short period of time. It demonstrates the commitment of vascular surgeons to continuously examine and change their practice to improve the quality of care for patients. But the variation in the times that patients wait from assessment to surgery show there is still more to do. Hospitals should review whether patients’ outcomes could be improved by reducing the time they wait between being assessed by a surgeon and undergoing an operation.”

The Vascular Society believes that the better outcomes for patients stem from a number of initiatives that aim to improve the quality of surgery. This includes the reorganisation of vascular units into larger specialised regional centres that are better placed to offer the full range of surgical services, 7-days a week. Increasing numbers of patients with AAA are also undergoing minimally invasive endovascular repair in the UK instead of more complex open surgery. The 2015 Annual Report found that, in 2014, two-thirds of patients had their AAA repaired using this minimally invasive technique. The Vascular Society believes this has played a significant role in improving patient outcomes.

*About HQIP, the National Clinical Audit Programme and how it is funded

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. www.hqip.org.uk

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