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Heart patients less likely to get surgery in UK than US, says report Ruptured aorta patients less likely to get surgery in UK than US, says report
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Death from a ruptured aorta – the main blood vessel from the heart – is more likely in UK hospitals than in the US, where patients have a better chance of getting an operation that could save their lives, according to a study.Death from a ruptured aorta – the main blood vessel from the heart – is more likely in UK hospitals than in the US, where patients have a better chance of getting an operation that could save their lives, according to a study.
American hospitals appear to be more willing to operate on a patient who arrives with a ruptured abdominal aortic aneurysm (AAA), a life-threatening emergency especially in men over 65. It happens when an aneurysm – a bulge in the artery wall – suddenly bursts, which can cause massive internal bleeding and death.American hospitals appear to be more willing to operate on a patient who arrives with a ruptured abdominal aortic aneurysm (AAA), a life-threatening emergency especially in men over 65. It happens when an aneurysm – a bulge in the artery wall – suddenly bursts, which can cause massive internal bleeding and death.
The NHS now offers screening to all men over the age of 65 to detect those at risk, who will be offered surgery to prevent a rupture occurring.The NHS now offers screening to all men over the age of 65 to detect those at risk, who will be offered surgery to prevent a rupture occurring.
Success rates even in such preplanned operations are highly variable around the UK, however, as a Guardian investigation using data obtained from hospitals under freedom of information legislation showed in 2010. Hospitals that did more AAA operations had lower death rates than those where surgeons only rarely carried them out.Success rates even in such preplanned operations are highly variable around the UK, however, as a Guardian investigation using data obtained from hospitals under freedom of information legislation showed in 2010. Hospitals that did more AAA operations had lower death rates than those where surgeons only rarely carried them out.
The NHS now collects mortality data from vascular surgeons that demonstrates the same pattern. The more practice a surgeon has, the more skilled it appears he or she becomes.The NHS now collects mortality data from vascular surgeons that demonstrates the same pattern. The more practice a surgeon has, the more skilled it appears he or she becomes.
The study, published in the Lancet, looks at emergency operations when a rupture has occurred. Without an operation, the patient will almost certainly die. The alternative is palliative care.The study, published in the Lancet, looks at emergency operations when a rupture has occurred. Without an operation, the patient will almost certainly die. The alternative is palliative care.
Alan Karthikesalingam and colleagues from St George's Hospital Vascular Institute in London found that only 58% of UK patients were offered emergency surgery compared with 80% in the US. Among American patients, there were 13% fewer deaths.Alan Karthikesalingam and colleagues from St George's Hospital Vascular Institute in London found that only 58% of UK patients were offered emergency surgery compared with 80% in the US. Among American patients, there were 13% fewer deaths.
"Most of the difference is attributable to the fact that when it appears in the US, patients are more likely to get surgery than in the UK," said Peter Holt, one of the authors."Most of the difference is attributable to the fact that when it appears in the US, patients are more likely to get surgery than in the UK," said Peter Holt, one of the authors.
The study shows that the best results – in both the UK and the US – are in large teaching hospitals. Surgeons in these hospitals were more likely to make the decision to operate and also more likely to use a technique called endovascular aneurysm repair (EVAR) – a newer, less invasive way of operating to put in a graft to keep the blood flowing through the aorta, rather than open surgery.The study shows that the best results – in both the UK and the US – are in large teaching hospitals. Surgeons in these hospitals were more likely to make the decision to operate and also more likely to use a technique called endovascular aneurysm repair (EVAR) – a newer, less invasive way of operating to put in a graft to keep the blood flowing through the aorta, rather than open surgery.
"The prevailing opinion is that EVAR is better," said Holt. "You are more likely to be discharged home rather than to nursing care. From the operative point of view, this paper would suggest there is a benefit to EVAR in lower mortality in the US and the UK.""The prevailing opinion is that EVAR is better," said Holt. "You are more likely to be discharged home rather than to nursing care. From the operative point of view, this paper would suggest there is a benefit to EVAR in lower mortality in the US and the UK."
The study also shows that patients who were taken at first to their district general hospital and then transferred to a teaching hospital were also more likely to survive.The study also shows that patients who were taken at first to their district general hospital and then transferred to a teaching hospital were also more likely to survive.
The findings of the study strongly support the case for centralising vascular surgery in fewer hospitals, where the surgeons will see more cases and become more expert at the operations. This is part of the thinking behind the move to reconfigure NHS services, but that regularly comes unstuck when politicians, local people and sometimes medical staff oppose plans to close under-performing hospital departments.The findings of the study strongly support the case for centralising vascular surgery in fewer hospitals, where the surgeons will see more cases and become more expert at the operations. This is part of the thinking behind the move to reconfigure NHS services, but that regularly comes unstuck when politicians, local people and sometimes medical staff oppose plans to close under-performing hospital departments.