Delays in carotid endarterectomy: the process is the problem

Current guidelines suggest carotid endarterectomy (CEA) for symptomatic carotid stenosis is most beneficial when performed within two weeks of symptoms. However, few patients receive the procedure within this timeframe. Prior research has shown that delays in CEA are common, but no prior work had resolved the specific causes of these delays. This gap motivated an examination of the timeline from symptom onset to CEA. Understanding the process delays could help improve care coordination. Delayed CEA may affect clinical outcomes, but the exact mechanisms remain unclear. The role of specialist referrals and imaging in this timeline has not been systematically analyzed. This study aimed to identify where delays occur and what factors contribute to them.

The study aimed to analyze the timeline from symptom onset to CEA in patients referred for the procedure. It focused on identifying the intervals between key steps in the care process. The researchers wanted to determine where the most significant delays occurred. They also aimed to explore the reasons for these delays when available. Understanding the process could inform strategies to reduce delays. The motivation was to improve the proportion of CEA procedures performed within the recommended two-week window. The study sought to provide evidence for where interventions might be most effective. It aimed to contribute to optimizing care pathways for patients with symptomatic carotid stenosis.

The study reviewed all CEA cases performed at a single institution by vascular surgery for symptomatic carotid stenosis after neurologist referral in 2008-2009. Researchers collected dates for symptom onset, initial presentation, and referrals to neurology and vascular surgery. They also recorded the timing of vascular imaging and the CEA procedure itself. The intervals between each step were analyzed to identify where delays occurred. Reasons for delays were noted when available in the medical records. The study used a retrospective design to examine the care process. Data were summarized using median and interquartile range values. The researchers focused on identifying patterns in the timeline of care.

Of the 36 patients included, 34 had CEA performed more than two weeks after symptom onset. The median time from symptom onset to CEA was 76 days. The longest interval was between surgeon assessment and the CEA procedure, averaging 14 days. Delays also occurred between neurology referral and assessment, averaging 9 days. The time between vascular imaging and referral to vascular surgery was 9 days. The interval between vascular surgery referral and assessment was 8 days. Only 44.1% of patients had identified reasons for delays. Process-related delays included delayed vascular imaging and inconsistent referrals from primary care. These findings suggest that the care process contributes significantly to delays.

The study found that significant delays occur between symptom onset and CEA in patients referred for the procedure. The highest delays were between specialist referral and evaluation. The authors suggest that process-related factors contribute to these delays. They propose that strategies to reduce these delays may increase the proportion of CEA performed within two weeks. The findings highlight the importance of optimizing care coordination. The authors note that delays may affect clinical outcomes, but further research is needed. They emphasize the need for interventions to streamline the care process. Their results support the idea that improving referral and evaluation timelines could enhance patient care.