Vascular surgery warning over 21 hospital trusts Fears over risk to patients if too few procedures carried out as surgeons say 100 in three years should be minimum.
More than 20 hospital trusts could be putting patients' safety at risk by continuing to carry out vascular surgery even though they do relatively few of the operations.
According to Dr Foster, a provider of healthcare information which publishes an annual hospital guide, 21 trusts are carrying out fewer than 100 abdominal aortic aneurysm (AAA) operations every three years.
The Vascular Society, the surgeons' professional body, says that 100 operations is the minimum necessary if hospital units are to be certain of doing this kind of surgery well.
More and more people are being referred for an AAA operation, but they may not know that some hospitals are likely to be safer than others.
All men over 65 are now offered screening for the condition, which occurs when the wall of the aorta, the large artery that takes blood away from the heart, balloons and becomes weak. When it ruptures before it can be repaired, about half of all patients die.
Last week, NHS England's medical director, Sir Bruce Keogh, published proposals to concentrate specialised A&E services in fewer hospitals. In London, stroke and heart attack victims are already taken by ambulance beyond the nearest hospitals to those where doctors are most experienced and skilled because they see more cases. It is now recognised that vascular surgery also should be carried out in fewer places.
In June 2010, the Guardian revealed that death rates following AAA surgery were variable across the UK and that hospitals that did more operations appeared to be safer.
In 2011 Dr Foster did its own analysis and found a 70% higher death rate in units carrying out fewer than 100 procedures every three years.
Many of the less busy units have now stopped offering AAA operations, instead pooling resources and patients with other hospitals in their region.
However, 21 hospitals which have low numbers of operations are still operating. Roger Taylor, director of research at Dr Foster, said: "These figures come in the light of recommendations from NHS England that acute emergency services need to be concentrated in specialised centres.
"Vascular surgery is one example of how this is happening across the NHS. The number of hospitals performing this operation infrequently has been falling for several years. However, it remains an issue in some parts of the country."
Taylor said the data also showed that England – outside London – was making little progress on concentrating stroke services in specialised centres. "London is on a completely different scale from anywhere else," he said.
Although there was an argument that in rural areas there were long distances to travel, that did not apply in areas of high population density such as the Midlands and north-east England. "In the north-east, stroke services are unchanged back to 2003," he said.
Ben Bridgewater, a cardiac surgeon who is working to improve the collection and publication of doctors' results at the Healthcare Quality Improvement Partnership (HQIP), said it was inevitable that transparency about outcomes would lead to increasing services in some hospitals but closing them in others.
Bridgewater said that even if surgeons' death rates were low it did not prove they were safe if they were doing just a few operations. "To demonstrate you are safe you have to have bigger volumes," he said. "You start very rapidly to move towards reconfiguration."
HQIP has collected data on individual doctors' performance in a number of specialities, now available on NHS Choices. "Now at least a person can get a choice between an individual doing five a year and an individual doing 100 a year and make a judgment on the basis of volume."
David Mitchell, head of the audit committee at the Vascular Society, said its recommended operating levels were only advisory but commissioners were increasingly requiring trusts to pool their services. "As ever, things move slowly, but the direction of change is clear," he said.
The 21 trusts are: Basildon and Thurrock University Hospitals NHS Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Bolton NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust, Dorset County Hospital NHS Foundation Trust, East and North Hertfordshire NHS Trust, Heatherwood and Wrexham Park Hospitals NHS Foundation Trust, Kettering General Hospital NHS Foundation Trust, Mid Yorkshire Hospitals NHS Trust, North Cumbria University Hospitals NHS Trust, Peterborough and Stamford Hospitals NHS Foundation Trust, Salisbury NHS Foundation Trust, South Devon Healthcare NHS Foundation Trust, Southend University Hospital NHS Foundation Trust, Tameside Hospital NHS Foundation Trust, The Princess Alexandra Hospital NHS Trust, The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, University Hospitals of Morecambe Bay NHS Foundation Trust, Wirral University Teaching Hospital NHS Foundation Trust, Wrightington, Wigan and Leigh NHS Foundation Trust . The Guardian
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