Patients with aortic aneurysm deserve higher priority
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《英国医生杂志》
Patients with an abdominal aortic aneurysm are waiting too long for surgery, says a report from the UK national confidential inquiry into patient outcome and death.
Just over a fifth of patients (21%) with aortic aneurysm who were reviewed for the inquiry waited more than 12 weeks for an elective repair operation, even though their condition was "life threatening," said the inquiry's chairman, Peter Simpson. He added, "Once a decision has been made to operate, this should be carried out as expeditiously as possible."
The inquiry found that 18 patients who had emergency surgery for aortic aneurysm (out of 264) in two months in 2004 had been on the waiting list for an operation. Anthony Gray, a consultant anaesthetist in Norwich and clinical coordinator for the inquiry, said that all 18 operations could have been avoided had prompt surgery been planned for the patients.
"If you have your operation planned then the mortality is 6%, but if your aneurysm bursts and a patient gets to hospital then the risk of mortality is six times higher at 36%," he said. "Also, it is not good for these patients to be waiting too long for their operation. They have been told of the seriousness of their condition, and every time they get a pain in their abdomen they think that is the end."
The inquiry collected data on all patients in England, Wales, and Northern Ireland who during February and March 2004 were admitted to hospital with an abdominal aortic aneurysm or who died from the condition without surgical intervention.
Of the 884 patients reviewed most (91%) needed surgery, and nearly two thirds of these (58%) were treated as elective patients. But cancellations resulting from a shortage of appropriate after-care facilities led to delays, says the report.
The report calls for aortic aneurysm patients who require surgery to have equal priority for diagnosis, investigation, and treatment as other patients with serious clinical conditions. It would not be inappropriate to expect as swift a response to a diagnosis of aortic aneurysm as to that for suspected cancer, for which there is a target to start treatment within four weeks of referral by the GP, said Dr Gray.
The report also recommended that trusts and clinical teams should cooperate more in concentrating elective surgery for aortic aneurysm in fewer hospitals that treat larger numbers of patients. The study found that 49 hospitals out of 181 surveyed performed 10 or fewer elective aneurysm repairs in 2002-3 and 87 hospitals did fewer than 10 emergency procedures.
"There are a number of patients being operated on by surgeons doing surprisingly small numbers of operations," said Dr Gray. "Although the numbers in our study are too small to show a difference in outcomes, there are published studies which show that clinicians and hospitals that do big volumes of elective aortic aneurysm operations get better outcomes."(Zosia Kmietowicz)
Just over a fifth of patients (21%) with aortic aneurysm who were reviewed for the inquiry waited more than 12 weeks for an elective repair operation, even though their condition was "life threatening," said the inquiry's chairman, Peter Simpson. He added, "Once a decision has been made to operate, this should be carried out as expeditiously as possible."
The inquiry found that 18 patients who had emergency surgery for aortic aneurysm (out of 264) in two months in 2004 had been on the waiting list for an operation. Anthony Gray, a consultant anaesthetist in Norwich and clinical coordinator for the inquiry, said that all 18 operations could have been avoided had prompt surgery been planned for the patients.
"If you have your operation planned then the mortality is 6%, but if your aneurysm bursts and a patient gets to hospital then the risk of mortality is six times higher at 36%," he said. "Also, it is not good for these patients to be waiting too long for their operation. They have been told of the seriousness of their condition, and every time they get a pain in their abdomen they think that is the end."
The inquiry collected data on all patients in England, Wales, and Northern Ireland who during February and March 2004 were admitted to hospital with an abdominal aortic aneurysm or who died from the condition without surgical intervention.
Of the 884 patients reviewed most (91%) needed surgery, and nearly two thirds of these (58%) were treated as elective patients. But cancellations resulting from a shortage of appropriate after-care facilities led to delays, says the report.
The report calls for aortic aneurysm patients who require surgery to have equal priority for diagnosis, investigation, and treatment as other patients with serious clinical conditions. It would not be inappropriate to expect as swift a response to a diagnosis of aortic aneurysm as to that for suspected cancer, for which there is a target to start treatment within four weeks of referral by the GP, said Dr Gray.
The report also recommended that trusts and clinical teams should cooperate more in concentrating elective surgery for aortic aneurysm in fewer hospitals that treat larger numbers of patients. The study found that 49 hospitals out of 181 surveyed performed 10 or fewer elective aneurysm repairs in 2002-3 and 87 hospitals did fewer than 10 emergency procedures.
"There are a number of patients being operated on by surgeons doing surprisingly small numbers of operations," said Dr Gray. "Although the numbers in our study are too small to show a difference in outcomes, there are published studies which show that clinicians and hospitals that do big volumes of elective aortic aneurysm operations get better outcomes."(Zosia Kmietowicz)