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Variation in time spent on the waiting list for elective vascular surgery: a case study
1Department of Surgery, Queen's University, Kingston, Ont. bs9@post.queensu.ca
Objective:
To review the variation in time spent on the waiting list for elective vascular surgery provided by a single team of specialists.
Design:
A prospective cohort study.
Setting:
An acute care hospital in Ontario.
Population:
One thousand and eighty-four consecutive patients with vascular problems accepted for elective surgery between 1994 and 1998.
Interventions:
Abdominal aortic aneurysm (AAA) repair; carotid endarterectomy (CAD); surgery for peripheral vascular disease (PVD); and arteriovenous fistula (AVF) for long-term access in patients with renal failure.
Outcome Measures:
Time-to-treatment curves, admission rates.
Results:
The weekly admission rate was 9.8% on average. The proportion of patients who underwent operation was 50% at 7 weeks, 75% at 14 weeks and 90% at 26 weeks. The weekly admission rate varied according to clinical priority, from 42% in priority class 1 to 6% in class 5. In any priority class, the admission rate was not constant over time. Although the proportion of patients operated on within the maximum recommended time in classes 1, 2, 3 and 4 was 52%, 50%, 35% and 20% respectively, the last 10% of patients waited 5 to 16 weeks, 10 to 16 weeks, 16 to 37 weeks, and 25 to 39 weeks respectively. There were statistically significant differences in waiting time by surgical procedure among the least urgent cases, with median times of 7, 10 and 19 weeks for AVF, PVD and CAD procedures, respectively.
Conclusions:
When queuing procedures are uniform, the waiting times for access to elective vascular surgery provided by the same team of specialists differ considerably for patients with equal surgical needs and urgency. It remains to be examined whether delays in scheduling operations and cancellations affect the waiting time after adjustment for urgency and comorbidity.