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Wait Times for Carotid Endarterectomy, London Ontario 2006-2007

Published online by Cambridge University Press:  23 September 2014

Erin Dyer ,
Stephen Lownie  and
Gary Ferguson
Erin Dyer
Affiliation:
Division of CNS, London Health Sciences Center, University of Western Ontario, University Hospital, London, Ontario, Canada
Stephen Lownie*
Affiliation:
Division of CNS, London Health Sciences Center, University of Western Ontario, University Hospital, London, Ontario, Canada
Gary Ferguson
Affiliation:
Division of CNS, London Health Sciences Center, University of Western Ontario, University Hospital, London, Ontario, Canada
*
Neurosurgery and Neuro-Radiology, University of Western Ontario, London Health Sciences Center, University Hospital, 339 Windermere Road, London, Ontario, N6A 5A5, Canada. Email: Steve.Lownie@lhsc.on.ca.
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Abstract

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Objective:

To examine time delays and identify factors that affect wait times from index neurological event to carotid endarterectomy in patients with symptomatic carotid stenosis treated at a regional neurosurgical referral centre.

Methods:

We performed a retrospective audit over two years of all patients who underwent a carotid endarterectomy at University Hospital, London, Ontario. The number of days was calculated from first neurological event through until surgery.

Results:

Eighty-nine carotid endarterectomies (CEAs) were performed by four surgeons during the years 2006 and 2007. From the first neurological event, the median wait time for surgery was 111 days, while from the last event the median wait time was 83 days. There was 19 days' wait between specialist / TIA clinic appointment and the receipt of neurosurgical referral. Median wait time for diagnostic imaging was eight days for carotid Doppler ultrasound and 15 days for CT or MR angiography. There was a 44 day wait from receipt of neurosurgical referral to the date of surgery. Only three patients (4%) received CEA within two weeks of their last neurological event. There was a trend towards a difference in wait times between inpatients and outpatients, but no difference between females compared with males, or between patients presenting with stroke versus TIA.

Discussion:

Median wait times for CEA after first neurological event was over three months at our center, reflecting the diagnostic workup required in TIA as well as the lack of a systematic approach. This is the subject of continued study at our institution.

Résumé:

Résumé:Objectif:

Le but de l'étude était d'examiner le temps d'attente et d'identifier les facteurs qui influencent le temps d'attente, du premier événement neurologique jusqu'à l'endartérectomie carotidienne, chez les patients présentant une sténose carotidienne symptomatique qui ont été traités dans un centre de référence neurochirurgical régional.

Méthode:

Nous avons effectué une vérification des dossiers de tous les patients qui ont subi une endartérectomie carotidienne au cours d'une période de 2 ans à l'University Hospital, à London, Ontario. Nous avons calculé le nombre de jours écoulés depuis le premier événement neurologique jusqu'à la chirurgie.

Résultats:

Quatre-vingt-neuf endartérectomies carotidiennes (EC) ont été effectuées par 4 chirurgiens au cours de 2006 et de 2007. Le temps médian d'attente pour la chirurgie depuis le premier événement neurologique était de 111 jours et il était de 83 jours depuis le dernier événement neurologique. Le temps d'attente pour obtenir un rendez-vous avec un spécialiste/à la clinique d'itc suivant la réception de la demande de consultation était de 19 jours. Le temps d'attente médian pour l'imagerie diagnostique était de 8 jours pour un écho-doppler de la carotide et de 15 jours pour une angiographie par tomodensitométrie ou par résonance magnétique. De la réception de la demande de consultation en neurochirurgie à la date de la chirurgie, il y avait 44 jours d'attente. Seulement 3 patients (4%) ont subi une ec dans les deux semaines suivant leur dernier événement neurologique. Il existait une tendance statistique vers une différence dans le temps d'attente entre les patients hospitalisés et les patients externes, mais aucune différence entre les hommes et les femmes ou entre les patients ayant consulté pour un accident vasculaire cérébral par rapport à ceux qui avaient présenté un accès ischémique transitoire cérébral. D is cu s s ion : Le temps médian d'attente pour une ec après le premier événement neurologique était de plus de 3 mois dans notre centre, ce qui tient compte de la démarche diagnostique requise lors d'un itc ainsi que de l'absence d'une approche systématique. Des études sur ce sujet sont en cours dans notre institution.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 3 , May 2013 , pp. 330 - 333
Copyright
Copyright © The Canadian Journal of Neurological 2013

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