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Title: A clinical & health economic evaluation of thoracic aortic aneurysm surgery
Author: Bashir, M.
ISNI:       0000 0004 6058 9224
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2016
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Thoracic aortic aneurysm is a life-threatening condition which affects different parts of the aorta. A significant proportion of patients present with incidental aneurysmal disease and are physically asymptomatic at the time of their first presentation. However, despite their asymptomatic nature the existence of an acute aortic syndrome represents a life threatening disease which is associated with a high mortality rate. Thus the effective and efficient diagnosis and treatment of such patients is essential in optimizing both their quality and quantity of life. This thesis takes advantage of a range of structural and policy changes that have been undertaken at Liverpool Heart and Chest Hospital (LHCH) to evaluate the impact of such changes on the clinical and cost effectiveness of aortic surgery. Foremost amongst these changes was the reorganization of the aortic service in 2007 to concentrate treatment in the hands of a small number of specialists. This thesis examines subspecialisation and reorganisation of surgical expertise and activity for the treatment of aortic surgery patients at LHCH resulted in significantly improved patient outcomes which is being achieved with cost neutral changes in service delivery. The thesis will assess the impact of this subspecialisation on a range of outcome dimensions including patient outcomes and the efficiency of resource utilization within the aortic service at LHCH. The focus of this study is in tune with increased sub-specialization in a wide range of therapeutic areas in hospitals throughout the UK. It is hoped that the methodology and findings of this study may contain lessons that may be applicable to specialisms outside aortic surgery throughout the NHS and assist in developing an evidence based health policy to inform the ever growing trend towards increased sub specialization. The improvements appeared to simply result from the natural enhancement of expertise that results from concentration of specialist surgery in fewer and hence more experienced hands. In this regard, centralization of thoracic aortic aneurysm service appears to enhance both survival. The generalizability of these findings and potential lessons for the provision of specialist surgery in other therapeutic areas await further investigation.
Supervisor: Haycox, A. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral