RURAL VASCULAR SURGERY

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What is Working in Rural General and Vascular
Surgery
2nd Annual Rural Surgery Symposium Cooperstown,
New York September 2006
Bill Rainer, MD, LRCSI, FACS Associate Clinical
Professor, Dept of Surgery, UCHSC Cortez,
Colorado
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Rocky Mountain Vascular Surgical Society

• 27th Annual Meeting
• August 3-6, 2006
• Mesa Verde National Park

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RURAL VASCULAR SURGERY

• What Works and What Doesnt

Presidential Address August 2006 Bill Rainer, MD,
LRCSI, FACS
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Background

• Cortez, Colorado
• Since 1989
• Population 9,000
• Service Area
• 5,000 square miles
• 35-40,000 people

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Hospital Resources

• Acute Care (49 beds), ICU (42 beds)
• ORs (32 endo)
• 3 Surgeons
• Non Invasive Vascular Lab
• Ultrasound, MRA, CTA
• Angiography, Oncology 50 miles

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Case Volume 1989-2005

• Total Operative Cases 8,618
• Major Vascular 217 (2.5)
• Aorta 40 (18) 2.7/year
• Carotid 64 (29) 4.3/year
• Peripheral 97 (45) 6.5/year
• Vascular Labs 750
• GI Endoscopy 2,685 (31)

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Case Volume 1989-2005

• Total Operative Cases 8,618
• Tonsils 81 (0.94) 5.4/year
• Vasectomy 128 (1.5) 8.5/year
• C-Section 44 (0.5) 3/year
• Tubes/Ovaries 109 (1.3) 7.3/year
• Carpal Tunnel 33 (0.4) 2.2/year
• Bronchoscopy 148 (1.7) 10/year

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Economics
Don't do this!
20k to 70k in 5yr
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Whats Working in Cortez? Rural General Surgery

• Endoscopy !
• Call Reimbursement !
• Surgeons getting along !
• Call Sharing
• Assisting
• (Often difficult, Always worthwhile)

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Whats Working in Cortez? Rural General Surgery

• Benchmarks/Process Improvement
• Western Slope Trauma Society
• Outpatient Surgery Center
• Medical Students
• Long Term, Close Follow-up

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Whats Working in Cortez? Rural Vascular Surgery

• Acceptable Outcomes
• Mortality
• Stroke

• Patency
• Vascular Lab Accuracy

• Emergency Operation and Triage
• Long Term, Close follow-up

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What Doesnt Work? Rural Vascular Surgery

• The Finances
• Extra liability expense approaching or exceeding
  vascular income
• Referrals
• Some internists believe the literature
• Interventional Procedures

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How to Make it Work? Rural Vascular Surgery

• Venous Ablation (RFA vs. laser)
• Perpetual Training and Diversity
• Operative techniques
• Catheter Skills
• Angioplasty, Stents, Stent Grafts, Thrombolysis,
  Atherectomy
• Medical Therapy
• Angiogram Suite vs. C-arm
• Industry Representatives

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Where Are We Headed? Rural General Surgery

• We Will Survive!
• Rural Surgeons are a key to the survival of rural
  hospitals.
• Rural Surgeons are a key to the survival of rural
  patients.

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Where Are We Headed? Rural Vascular Surgery

• We May Not Survive!
• Centralized Vascular Care
• More Expensive Vascular Care
• Business-based Vascular Care
• Eventual Decrease in Rural Quality ?

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Thank You

• Mithoefer Center for Rural Surgery
• Southwest Memorial Hospital
• Rocky Mountain Vascular Surgical Society