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Current differences in referral patterns for pulmonary endarterectomy in the UK

¹ Papworth Hospital NHS Trust, Papworth Everard, ² Royal United Hospital, Bath, ³ Medical Research Council (MRC) Biostatistics Unit, ⁴ Eastern Region Public Health Observatory (ERPHO), Institute of Public Health, ⁵ University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK., ⁶ Both authors contributed equally to this article

CORRESPONDENCE: J. Suntharalingam, Royal United Hospital, Bath, UK. Fax: 44 1480364998. E-mail: jaysunth{at}btopenworld.com

Keywords: Pulmonary hypertension, thromboendarterectomy

Received: January 15, 2008
Accepted April 7, 2008

Pulmonary endarterectomy (PEA) surgery is the treatment of choice in surgically accessible chronic thromboembolic pulmonary hypertension and is potentially curative. The UK is served by seven specialist pulmonary hypertension centres and, consequently, there are regions which do not have a specialist unit. Since 2000, Papworth Hospital (Papworth Everard, UK) has been the sole PEA provider for the UK, offering the opportunity to study the national incidence of operable disease and give potential insight into factors that might affect geographical distribution within the UK.

All 262 UK residents who underwent PEA surgery between April 2000 and May 2006 were included in the present study. The age-adjusted cumulative referral rates were compared between regions to test for uniformity.

Overall, observed rates differed significantly from expected, with evidence of significant nonuniformity across the UK. The highest rates were observed in proximity to the nationally designated specialist centres and in particular in East Anglia and the West Midlands, nearest Papworth. These two regions differed by >2xSD from the national mean rate.

The present study demonstrates wide geographical variation in the number of patients referred for pulmonary endarterectomy surgery. This suggests that there may be patients who are not presently being offered this potentially curative option.

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