Sub-specialisation in neurosurgery: perspective from a small specialty.

BACKGROUND: There is an increasing tendency towards sub-specialisation in the larger surgical specialties. The feasibility and effectiveness of this is less clear in the smaller specialties with limited manpower such as neurosurgery. PATIENTS AND METHODS: To evaluate this, we carried out an audit comparing the throughput and outcome of patients treated for intracranial aneurysms in our unit before and after a period of neurovascular sub-specialisation. RESULTS: In the period before sub-specialisation, 68 aneurysms were treated compared to 69 after sub-specialisation. The epidemiological profile of patients, their clinical condition at presentation and the location of aneurysms were not significantly different in the two periods. There was less morbidity and mortality and better long-term functional outcome (P = 0.05) following sub-specialisation. More investigations including cerebral angiograms were performed after sub-specialisation. The added cost, however, was offset against savings made by the shorter length of patient's hospital stay (P = 0.002). CONCLUSIONS: Sub-specialisation appears to confer benefits both in terms of patient outcome and socio-economic gain.