Policy related to varicose veins in publicly funded elective surgery programs: a comprehensive systematic review

Objectives  This systematic review set out to establish best practice in relation to policy for the inclusion/exclusion of varicose vein procedures within public health systems. Inclusion criteria  The review considered any studies relating to varicose veins that addressed issues of inclusion/exclusion from publicly funded health systems including criteria for clinical need, contraindications, fit/ready for surgery, policy compliance and issues in relation to surgical training. Search strategy  The search strategy sought to find published and unpublished studies that were limited to English. An initial search of Medline and CINAHL was undertaken, followed by an analysis of key words contained in the title, abstract and index terms. A second comprehensive search was then undertaken using Medline, CINAHL, EMBASE, AUSTROM, Health Business FullTEXT Elite and PsycINFO. The search was restricted to the period 1995-2005. Methodological quality  Each paper was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information software (JBI-SUMARI). Results  A total of nine papers were included in the review. Because of the diverse nature of these papers, meta-analysis and synthesis of the results was not possible. For this reason, results are presented in narrative form. The majority of papers included in the review related to the identification of indicators for surgical intervention for the treatment of varicose veins. Other major themes were related to measures of quality of life of patients with varicose veins and the potential for surgical training. Recommendations for practice and research 1 Reasons for presentation should be thoroughly examined before any decision is made regarding surgery for varicose veins and indications documented thoroughly. 2 Every effort should be made to ensure opportunities are available to trainees within the constraints of the system. 3 In considering varicose veins surgery specifically, there would be value in examining further the use of psychometric scales/instruments to assess individual need for surgery. 4 The financial impact of varicose veins surgery should be investigated by way of a cost utility study. 5 Further investigation of the impact of excluding varicose vein surgery on training would be warranted.