Development of a Vascular Surgery Maximum Surgical Blood Ordering Schedule in a Tertiary Referral Centre

Abstract

CSHA) mFI) is a verified, practical system consisting of 11 items. Three hundred and eighty-four patients referred to the vascular clinics with a diagnosis of AAA over the past three years were included. Of those unfit for surgery and/or continued surveillance, records for positive mFI features were retrospectively reviewed. Results: A total of 63 patients fit the criteria. 39 patients were <5.5cm; seven (11.1%) were small (<4cm), seven (11.1%) declined surveillance and 25 (39.7%) were withdrawn from surveillance due to co-morbidities. These 25 patients had an average of 2.9 mFI items. 24 patients had an AAA >5.5cm. Of these, six (9.5%) declined intervention, 18 (28.6%) were turned down for surgical intervention due to comorbidities. Those turned down for surgery had an average of 3.5 mFI items. Elective AAA repair patients for the same period had an average of 1.4 mFI items. Conclusion: The study shows that a Standardised Frailty Index Scoring System correlated closely with senior clinician decision making. While there is no substitute for clinical experience, such an objective scoring system could aid a surgeon's decision and also provide medico-legal protection.