Editorials

The future of vascular services: the need for a strategy

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7110.695 (Published 20 September 1997) Cite this as: BMJ 1997;315:695

Which could also be a model for other specialist services

  1. John H N Wolfea, Consultant vascular surgeon
  1. a St Mary's Hospital, Praed Street, London W2 1NY

How big should an acute general surgical hospital be and what population should it serve? Patients want a local service, but technological advances, increasing expectations, and escalating costs make this difficult. Vascular surgery provides an important benchmark against which to judge the optimum size of acute surgical units.

Since the 1960s vascular surgery has been one of the most rapidly expanding specialties. Indeed in 1994-5, 25% of general surgical appointments requesting a special interest were for a vascular surgeon (the next most popular request was colorectal surgery, at 10%). Patient morbidity and mortality have been dramatically reduced by (expensive) improvements in anaesthetic and perioperative care. A better understanding of the widespread nature of the disease has led to close cooperation between surgeon, cardiologist, renal physician, and neurologist. Furthermore, interventional radiologists have …

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