Aortic aneurysm repair in a peripheral setting: Audit 100 consecutive cases

Background: Subspecialization of vascular surgery and the advent of endovascular techniques for aortic aneurysm repair have had a large impact on the approach to aortic surgery in main centres. Centralization of vascular surgery has been proposed to lower mortality and morbidity rates. More recently, clinical governance standards have been set by professional bodies for acceptable adverse outcome rates in aortic surgery. A peripheral general surgeon's experience with aortic surgery is reviewed in the present report in order to identify the local adverse outcome rates, and to relate them to case data and governance recommendations. Methods: A retrospective audit of 100 cases of elective and emergency aortic aneurysm repair (performed by the senior author over a 10-year period) was undergone for the present review. Demographic and outcome data were recorded, and a data analysis was performed to identify factors related to mortality. Significance was tested using chi-squared analysis. Results: Postoperative mortality rates were 1.7% for elective cases and 21% for acute cases. Mortality was related to rupture of the aneurysm, blood loss and American Society of Anesthetists score > 3. Conclusion: Morbidity and mortality rates from this audit compare favourably with those from larger vascular units. They are well within the accepted clinical governance rates, although the latter do not account for any case mix variation which may exist between peripheral and tertiary referral centres. These results support the continuation of aortic aneurysm surgery in peripheral centres.