The Risk of Vascular Surgery in a Metropolitan Community. With Observations on Surgeon Experience and Hospital Size

From 1978 through 1981 complete perioperative information concerning a total of 10,189 peripheral vascular procedures performed in northeastern Ohio was recorded in the computer registry of The Cleveland Vascular Society. This report is an analysis of mortality and morbidity rates for all 5686 operations involving carotid endarterectomy (N = 2646), lower extremity revascularization (N = 1987), and abdominal aortic aneurysm resection (N = 1053). The operative mortality rate was 1.2% for carotid reconstruction, 2.8% for femoropopliteal or distal bypass, 3.5% for aortofemoral revascularization, and 11.9% for aortic aneurysm resection (elective operations 6.5%; emergency operations 32.9%). Postoperative strokes occurred after endarterectomy in 2.7% of patients having preoperative neurologic symptoms and in 2.0% of those with asymptomatic carotid stenosis. Lower extremity amputation was unavoidable in 1.5% of patients after aortofemoral reconstruction and in 6.0% after femoropopliteal or distal bypass. Statistical testing indicated that the operative mortality rate was not related to the respective size of the 27 hospitals involved in the survey. The relative annual experience of the 29 participating surgeons significantly influenced only the mortality rate of elective aneurysm resection and the amputation rate after femoropopliteal or distal revascularization. This study suggests that the results of major arterial reconstruction in metropolitan areas may be expected to be comparable to those of published series if the responsible surgeons are specifically trained and maintain an active interest in the field of vascular surgery.