Reducing the delay for carotid endarterectomy in South-East Scotland

To establish whether the Scottish Intercollegiate Guidelines Network guidelines (SIGN 2008) publication has improved the delay from neurological event to carotid endarterectomy (CEA). This ideally should be performed within two weeks of a patient experiencing their first neurological event.

Data for 255 consecutive, symptomatic CEA procedures carried out under local anaesthetic, between March 2007 and June 2010 at The Edinburgh Vascular Surgery Service (EVSS) were extracted from the National Vascular Database. The mean, median and range was calculated for days from symptoms to vascular referral, vascular assessment to surgery and symptoms to surgery, subdivided according to four hospitals referring to the EVSS and whether CEA was performed pre- (n = 128) or post-publication of guidelines (n = 127).

Median delays from symptoms to vascular referral, vascular assessment to surgery and symptoms to surgery have decreased in all hospitals since the publication of the guidelines. The proportion of patients undergoing CEA within two weeks after their initial event increased from 25% pre-guidelines to 40.2% post-guidelines (p = 0.04). The proportion of patients undergoing CEA within four weeks of their event also improved from 57% to 74%. Patient presentation (41.8%), late referrals (29.9%) and lack of resources (22.4%) were the main causes for delay.

Guidelines have improved service provision for CEA at the EVSS. However, more work is required to address the subgroup of patients whose surgery was delayed as a result of late presentation, late referral and lack of surgical resources.