Factors influencing waiting times for elective laparoscopic cholecystectomy

Health Canada states that waiting list information and management systems in Canada are woefully inadequate, especially for elective surgical procedures. Understanding the reasons for waiting is paramount to achieving fairness and equity. The objective of this study was to examine the impact of demographic and clinical factors and surgeon volume on waiting times for laparoscopic cholecystectomy (LC).

We comprehensively applied a wait-list database for all surgical procedures across a division of general surgery and performed a chart review of all patients undergoing LC in 2002 to collect additional demographic and clinical data. We excluded patients undergoing LC on an emergent basis or as a secondary procedure. For each patient, we calculated 2 time intervals: time from the receipt of consult to the surgical consult (interval A) and time from the surgical consult to the LC (interval B). Surgeons were categorized a priori into low- and high-volume groups, based on the median number of procedures they had performed. All analyses examining waiting times were performed with nonparametric methods.

The study cohort included 294 patients; most (94.6%) underwent LC for biliary colic. The median waiting times for interval A and interval B were 22 days and 50 days, respectively. No associations were identified between any of the examined waiting times, sex, diagnosis or Charlston Comorbidity Index. High surgeon volume was associated with longer waiting times for interval A (median 26 v. 19 d; p=0.04) and interval B (median 58 v. 35 d; p=0.003) and was also associated with a greater number of episodes of biliary colic (2.7 v. 2.0; p=0.03).

There is significant variability in specific waiting times for LC, which appears to be associated with surgeon volume. Better prioritization of patients undergoing nonemergent LC is required to improve patient care.