Bilateral varicose vein surgery in the UK

2006 ◽  
Vol 21 (1) ◽  
pp. 12-15 ◽  
Author(s):  
K Overbeck ◽  
D Zubrzycka ◽  
G Stansby
Keyword(s):  
Decision Making ◽  
Health Economic ◽  
Great Britain ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Economic Implications ◽  
The Uk ◽  
Significant Health

Objective: To assess the views of surgeons in the UK concerning the surgical management of patients with bilateral varicose veins (BVV) requiring surgery. Methods: A postal questionnaire was sent to members of the Vascular Society of Great Britain and Ireland. Questions concerned the use of BVV surgery in general, its use on day-case patients and which factors influenced decision-making in this area. Results: In all, 63% of surgeons never or only occasionally performed BVV surgery as a day case, whereas only 27% never or only occasionally performed BVV surgery on inpatients. The majority (70.2%) were not influenced by patient age or occupation (81.9%). The patient's general health was, however, a factor in decision-making for the majority (60.1%), as was the extent of the varicosities (52.8%). Other important factors were the availability of a second surgeon and a perception that there was likely to be increased morbidity with BVV surgery. Conclusions: There appears to be considerable variation between individual surgeons in the UK with regard to BVV surgery. This is manifested mainly as a reluctance to perform BVV as a day case by a significant number of surgeons. As there is no randomized trial(s) in this area, no firm guidance can be given. The issue is worthy of further study and may have significant health economic implications.

Day Case Varicose Vein Surgery: Patient Health Outcome

2001 ◽  
Vol 16 (4) ◽  
pp. 160-163
Author(s):  
K. J. Sweeney ◽  
T. Cheema ◽  
S. O'Keefe ◽  
S. Johnston ◽  
P. Burke ◽  
...  
Keyword(s):  
Physical Function ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Well Being ◽  
Health Perception ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Population Norms ◽  
Patient Health ◽  
The Impact

Background: The success of day case varicose vein surgery (DCWS) is traditionally denned clinically. However, the patient's perception of his or her own health prior to and following DCWS has not been established. This study prospectively measured the health status of patients with varicose veins, compared this with established population norms and assessed the impact of DCWS on both general health perception and varicose vein symptoms. Method: Fifty-three consecutive patients undergoing DCWS over a 9 month period were enrolled in this study. The SF-36 health assessment questionnaire and a vein-symptom-specific questionnaire were administered on the morning of surgery, 7 weeks postoperatively and 1 year following surgery. All patients in this study underwent a standard varicose vein operation and followed a standard protocol of postoperative management. Results: DCWS population health scores were lower than general population norms preoperatively. There was a significant improvement in the 7 week postoperative group in physical function and health perception (p<0.05). One year after surgery physical function, health perception, mental health and physical role were significantly improved from preoperative scores (p<0.05). Symptom-specific scores demonstrated a sustained trend towards improvement over the postoperative year. Conclusion: Varicose veins are associated with diminished well-being. Day case varicose vein surgery improves patient health perception and symptoms and is the treatment of choice for suitable patients with varicose veins.

Day-Case Surgery: A Viable Alternative for Surgical Treatment of Varicose Veins

1987 ◽  
Vol 2 (2) ◽  
pp. 103-108 ◽  
Author(s):  
D.C. Berridge ◽  
G.S. Makin
Keyword(s):  
Patient Group ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Viable Alternative ◽  
Patient Treatment ◽  
Case Group ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Day Case Surgery ◽  
Case Surgery

One hundred and forty-eight patients (164 limbs) who had varicose vein surgery by the same consultant surgeon 3–10 years previously were reviewed; 61 patients had surgery as an in-patient and 87 as a day-case. The patients were reviewed to assess the efficacy and acceptability of day-case varicose vein surgery. There were no significant differences between the age and sex ratios of the patients. However, twice as many operations in the in-patient group included stripping of the long saphenous vein above the knee (χ2 = 4.2, P = 0.04). Fifteen in-patients had bilateral vein surgery as opposed to only one day-case patient. Fifteen patients suffered complications most of which were minor and were evenly distributed including wound infections (nine), reactionary haemorrhage/haematoma (four), deep vein thrombosis (one) and pulmonary embolus (one). The convalescent period before returning to work was similar in the two groups (U= 953, P= 0.28). The mean duration of stay for the in-patients was 3.9 ± 2.2 days. There was no significant difference in the period off work (day-case: 3.6 ± 2.0 weeks; in-patient: 4 ± 2.9 weeks), or in the length of follow-up (day-case: 6.01 ± 1.24 years; in-patient: 6.79 ± 1.71 years). In the period before review 11 patients in the in-patient group and 13 patients in the day-case group had further surgery or sclerotherapy for recurrent symptomatic varicose veins. At review five patients in the in-patient group and six patients in the day-case group had recurrent sapheno-femoral incompetence (χ2 = 0.1, P = 0.7). A total of 34 patients in both groups had recurrent varicose veins. Only four (4.6%) of the day-case patients expressed a preference for in-patient treatment if they were to have further surgery and 21 (34%) of the in-patient group would prefer day-case surgery. Day-case varicose vein surgery has not been shown to be inferior in terms of complications or recurrence rate. Patient acceptability is good and it is a viable alternative to in-patient treatment in suitable patients in areas with adequate district nurse facilities.

scholarly journals Management of Varicose Veins: A Survey of Current Practice by Members of the Vascular Society of Great Britain and Ireland

2009 ◽  
Vol 91 (1) ◽  
pp. 77-80 ◽  
Author(s):  
AG Edwards ◽  
S Baynham ◽  
T Lees ◽  
DC Mitchell
Keyword(s):  
Great Britain ◽  
Private Practice ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Clinical Excellence ◽  
Foam Sclerotherapy ◽  
Ultrasound Assessment ◽  
Primary Varicose Veins ◽  
The Uk ◽  
E Mail

INTRODUCTION In 1999, a survey was published detailing the management of varicose veins by members of the then Vascular Surgical Society (VSS). Since then, newer methods for treating varicose veins have been developed and far more explicit rationing has been introduced in the NHS. SUBJECTS AND METHODS In order to examine whether there had been a significant change in established practice in the UK, a questionnaire was sent to all Vascular Society of Great Britain and Ireland (VSGBI) members in the 2004 yearbook by E-mail or post. RESULTS Of the 426 questionnaires distributed, a 69% response rate was achieved. Of respondents, 97% treated varicose veins in their NHS practice, whilst 88% did so in private practice. Some 73% used hand-held Doppler assessment in the clinic and 96% used duplex ultrasound assessment selectively. Despite UK National Institute for Health and Clinical Excellence (NICE) guidelines, only 68% said that their primary care trusts funded treatment of symptomatic varicose veins, while 93% did so for complications. In either NHS or private practice, respectively, 83% or 72% of responders offered surgery as preferred treatment for primary varicose veins, while 14% or 20% preferred endovascular treatments (endovascular laser treatment, radiofrequency ablation and foam sclerotherapy). Of responders, 17% did not follow-up patients after treatment. CONCLUSIONS This survey suggests that there is rationing of access to care for symptomatic varicose veins. Despite publicity for endovenous techniques, surgery remains the preferred treatment for varicose veins in the UK.

The early morbidity of varicose vein surgery

1995 ◽  
Vol 81 (1) ◽  
pp. 42-46
Author(s):  
D C Mackay ◽  
D J Summerton ◽  
A J Walker
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Population Group ◽  
Postal Questionnaire ◽  
Varicose Vein Surgery ◽  
Long Saphenous Vein ◽  
Case Surgery ◽  
Post Operation ◽  
The Difference ◽  
Considerable Morbidity

AbstractThe early outcome and morbidity associated with varicose vein surgery were assessed at six months post operation by postal questionnaire. Most cases underwent sapheno-femoral ligation, above-knee stripping of the long saphenous vein and multiple stab avul sions. A 73.8% response rate resulted in 155 replies, and revealed a high incidence (65.8%) of perceived complications within the first two weeks after surgery. The commonest of these were bruising, pain and numbness. Over a third of patients consulted their general practitioner (GP) postoperatively. Half of these required further management or treatment and the rest, reassurance alone. At six months 79.4 % were satisfied with the outcome of their surgery, although some still claimed problems with residual veins, skin discoloration, numbness, and ankle or foot disco loration. Eleven percent were referred to hospital for further opinion, mostly because of perceived residual varicose veins. The difference between residual and recurrent varicose veins is discussed. No patient fe lt that the standard 2.5 day admission was too long, and 12.9% thought it too short. Day case surgery is not a popular option in this population group.Despite high satisfaction rates, there is a considerable morbidity attached to varicose vein surgery. We believe that good pre- and perioperative communication, augmented by a comprehensive information sheet, is important to prepare patients for those postoperative problems and thus reduces their perceived importance.

scholarly journals Views of child psychiatrists on physical contact with patients

2006 ◽  
Vol 188 (5) ◽  
pp. 486-487 ◽  
Author(s):  
Aileen Blower ◽  
Roddy Lander ◽  
Anna Crawford ◽  
Ruth Elliot ◽  
Clare McNulty ◽  
...  
Keyword(s):  
Decision Making ◽  
Great Britain ◽  
Telephone Survey ◽  
Postal Questionnaire ◽  
Physical Contact ◽  
Patient Comfort ◽  
Professional Experience ◽  
Conservative Approach ◽  
Therapeutic Value ◽  
And Training

SummaryThe appropriateness and therapeutic value of physical contact with children is under increasing scrutiny. We conducted a postal questionnaire and telephone survey of consultant child and adolescent psychiatrists within Great Britain to investigate attitudes of specialists towards physical contact with their patients in different clinical contexts. Here we report that psychiatrists tend to restrict physical contact to the minimum essential for patient comfort or safety. Decision-making about contact is primarily influenced by professional experience and training. This conservative approach to physical contact with patients has implications for clinical practice and requires to be better informed by evidence.

Audit of varicose vein surgery: the patients' perspective

2005 ◽  
Vol 20 (4) ◽  
pp. 179-182 ◽  
Author(s):  
P S Sains ◽  
K M Reddy ◽  
H J S Jones ◽  
J K Derodra
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Surgical Patient ◽  
Varicose Vein Surgery ◽  
Patient Dissatisfaction ◽  
Modifiable Factors ◽  
Patients Perspective

Objectives: Varicose veins cause varying symptoms and post-surgical patient dissatisfaction is not uncommon. We aimed to identify patients' reasons for having surgery and sought to identify measures for improvement. Methods: A postal questionnaire was sent to patients. The patients' preoperative symptoms and postoperative satisfaction were enquired upon. Replies were cross-referenced to the operation notes. Results: Three hundred and thirty-five patients completed the questionnaire. The consultant carried out 73% of operations, with 27% being carried out by trainees. In all, 41% of patients were very satisfied with surgery, 39% were satisfied, 17% were dissatisfied and 4% were very dissatisfied. In those whose operation was carried out by a consultant, 18% were dissatisfied as compared with 31% of those operated on by a trainee. Conclusion: The vast majority of patients are satisfied with varicose vein surgery and there are modifiable factors such as grade of surgeon and supervision, which can influence the outcome and satisfaction.

Compression regimes after endovenous ablation for superficial venous insufficiency – A survey of members of the Vascular Society of Great Britain and Ireland

2015 ◽  
Vol 31 (1) ◽  
pp. 16-22 ◽  
Author(s):  
J El-Sheikha ◽  
S Nandhra ◽  
D Carradice ◽  
C Acey ◽  
GE Smith ◽  
...  
Keyword(s):  
Great Britain ◽  
Venous Insufficiency ◽  
Current Practice ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Compression Stockings ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Endovenous Ablation ◽  
Superficial Venous Insufficiency

Introduction The optimal compression regime following ultrasound guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) for varicose veins is not known. The aim of this study was to document current practice. Methods Postal questionnaire sent to 348 consultant members of the Vascular Society of Great Britain and Ireland. Results Valid replies were received from 41% ( n = 141) surgeons representing at least 68 (61%) vascular units. UGFS was used by 74% surgeons, RFA by 70% and EVLA by 32%, but fewer patients received UGFS (median 30) annually, than endothermal treatment (median 50) – P = 0.019. All surgeons prescribed compression: following UGFS for median seven days (range two days to three months) and after endothermal ablation for 10 days (range two days to six weeks) – P = 0.298. Seven different combinations of bandages, pads and compression stockings were reported following UGFS and four after endothermal ablation. Some surgeons advised changing from bandages to stockings from five days (range 1–14) after UGFS. Following endothermal ablation, 71% used bandages only, followed by compression stockings after two days (range 1–14). The majority of surgeons (87%) also treated varicose tributaries: 65% used phlebectomy, the majority (65%) synchronously with endothermal ablation. Concordance of compression regimes between surgeons within vascular units was uncommon. Only seven units using UGFS and six units using endothermal ablation had consistent compression regimes. Conclusion Compression regimes after treatments for varicose veins vary significantly: more evidence is needed to guide practice.

The Influence of Effective Analgesia and General Anaesthesia on Patients' Acceptance of Day Case Varicose Vein Surgery

1993 ◽  
Vol 8 (1) ◽  
pp. 29-31 ◽  
Author(s):  
O. C. Onuma ◽  
P. E. Bearn ◽  
U. Khan ◽  
P. Mallucci ◽  
M. Adiseshiah
Keyword(s):  
General Anaesthesia ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
College Hospital ◽  
Day Case Surgery ◽  
Patient Interview ◽  
Case Surgery ◽  
Analgesia Requirement

Objective: To assess the efficacy of locoregional anaesthesia and non-opiate analgesia in controlling pain after varicose vein surgery. To examine patient attitudes to day case surgery for this condition. Design: Prospective single patient group study (22 consecutive patients). Setting: University College Hospital (Teaching Hospital). Intervention: Locoregional and general anaesthesia. Non-opiate analgesia. Surgical treatment for varicose Main outcome measures: Patient interview, pain scores, analgesia requirement. Result: Post operative Pain was absent in 36% during the first 24 hours. Oral analgesia was given to 36% as inpatients but only 18% after discharge. Before surgery, 95% would have preferred DCS but only 24% at six months. The after-effects of general anaesthesia was the main reason for this change in attitude. Conclusions: Patients would like day case surgery for varicose veins but anaesthesia and analgesia must be satisfactory.

scholarly journals Treatment of Varicose Veins: The Present and the Future – A Questionnaire Survey

2008 ◽  
Vol 90 (7) ◽  
pp. 561-564 ◽  
Author(s):  
RJ Winterborn ◽  
CRR Corbett
Keyword(s):  
Great Britain ◽  
Private Practice ◽  
Questionnaire Survey ◽  
Varicose Veins ◽  
Treatment Options ◽  
Postal Questionnaire ◽  
Foam Sclerotherapy ◽  
Improved Outcomes ◽  
Change In Practice ◽  
Future Practice

INTRODUCTION The treatment options for varicose veins have increased over the last few years. Despite alack of randomised trials comparing the various modalities, many surgeons are changing their practice. The aim of this study was to assess the current practice of surgeons in Great Britain and Ireland. MATERIALS AND METHODS A postal questionnaire survey was sent to surgical members of the Vascular Society of Great Britain and Ireland and the Venous Forum of The Royal Society of Medicine. Of 561 questionnaires sent, 349 were returned completed (62%). RESULTS The types of varicose vein treatments offered by each surgeon varied widely in both NHS and private practice. The vast majority (96%) offered conventional surgery (CS) on the NHS. Foam sclerotherapy (FS) endovenous laser (EVL) and radiofrequency ablation (RF) were more likely to be offered in private practice than in NHS practice. Overall, 38% of respondents for NHS practice and 45% of respondents for private practice offered two or more modalities. Of the respondents who were not yet performing FS, EVL, or RF, 19% were considering or had undertaken training in FS, 26% in EVL and 9% in RF. When asked to consider future practice, 70% surgeons felt that surgery would remain the most commonly used treatment. This was followed by FS (17%), EVL (11%) and RF (2%). CONCLUSIONS Over one-third of respondents are now offering more than one treatment modality for the treatment of varicose veins. Whilst there is movement towards endovascular treatments, the problem of cost has yet to be solved. At present, surgery remains the most popular modality in both the NHS and private practice; however, improved outcomes and patient preference may lead to a change in practice.

Informed consent: what do we tell patients about the risk of fatal pulmonary embolism after varicose vein surgery?

2005 ◽  
Vol 20 (4) ◽  
pp. 175-178 ◽  
Author(s):  
A Srilekha ◽  
N Karunanithy ◽  
C R R Corbett
Keyword(s):  
Pulmonary Embolism ◽  
Great Britain ◽  
Varicose Vein ◽  
Response Rate ◽  
Postal Questionnaire ◽  
Pulmonary Emboli ◽  
Fatal Pulmonary Embolism ◽  
Varicose Vein Surgery ◽  
Small Risk ◽  
Official Sources

Objective: To obtain an estimate of the frequency of fatal pulmonary embolism (PE) after varicose vein surgery. Methods: Firstly by analysis of official statistics and secondly by a postal questionnaire to surgeons carrying out varicose vein surgery. The response rate from the questionnaire was 68% (391/576). Surgeons were asked if they had encountered PE after varicose vein surgery, whether the outcome was fatal and how many years they had spent in the specialty. Further calculations were based on data obtained from the Vascular Society of Great Britain and Ireland that suggest that on average about 120 cases are operated per year per consultant surgeon. Results: Analysis of the statistics available from official sources suggested that the risk of fatal PE after varicose vein surgery is about 1 in 15,000. Respondents to the questionnaire reported a total of 396 pulmonary emboli, of which 73 were fatal. From the questionnaire, we estimate that between one in three and one in four surgeons will encounter a fatality in the course of a full career. From knowledge of the length of time spent in the specialty by our respondents and using the figure of 120 operated cases per consultant per year, we obtained a higher estimate of the risk of fatal PE, around one in 10,000 cases. Conclusions: While the methods used to collect these figures are imperfect and open to criticism, they suggest a risk between one in 10,000 and one in 15,000. We think it is reasonable, when obtaining consent, to warn patients of the very small risk of fatal PE, using the more pessimistic figure of one in 10,000.

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