But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Monday, April 30, 2007

What Works -- Part 7 -- Vascular Surgery Successes

This is one of the posts in which I simply brag about the excellent clinical work I see at this hospital.

We see many, many patients here with diabetes. Notwithstanding improved care of diabetic patients, one of the unfortunate problems they face is vascular disease, particularly in the lower extremities. So patients sometimes show up with the prospect of needing a foot or limb amputation.

It turns out that our vascular surgeons are extremely competent at fixing malfunctioning blood vessels, either by grafting new ones or inserting stents to reopen the original ones. There have been many cases where patients have learned that they could retain their foot after this surgery. I have had a chance to watch these procedures, and you really have to marvel at the ability of surgeons to repair extremely tiny blood vessels in the lower leg.

Here is a summary of activity in our Vascular Surgery division. Over 4000 revascularizations have been performed since 1990. The overall mortality rate is 1.1 %, which is substantially less than reported across the country at high volume centers (4.9%) .

The effectiveness of graft surgery is measured by patency, "the state or quality of being open, expanded, or unblocked." The first chart above shows the record for our hospital for bypass grafts to the foot. (On the chart, primary -- meaning no further intervention necessary -- is shown below; secondary -- meaning some revisit for clotting or another problem, is the line above above). Randomized trials elsewhere show one year patency of about 60%. We show similar results five years after surgery.

Another measure of success is the ability to save limbs over an extended period of time. The second chart above shows the results on this score for our surgeons. Many other institutions show 50 to 80% limb salvage after one year. Our place shows 78% after five years.

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