Assessment of patient waiting times for vascular surgery

OBJECTIVES: To assess patient waiting times for vascular surgery and to det ermine if complications of the disease develop while the patients are await ing surgery. DESIGN: Prospective cohort study. SETTING: A university-affiliated tertiary care institution. PATIENTS: Ail 554 patients who underwent scheduled vascular surgical proced ures between April 1995 and October 1996. OUTCOME MEASURES: A literature review carried out to develop guidelines for acceptable waiting times for surgery associated with various vascular diso rders based on their natural history (benchmark target); actual waiting tim es, defined as the interval from the date each patient was booked for surge ry to the date of admission to hospital for the procedure; the proportion o f patients admitted within the benchmark targets; and whether prolonged wai ting time placed patients at risk for complications of their disease. RESULTS: Of the 554 patients, 382 (69%) were admitted within the benchmark waiting times. Of 84 patients having an abdominal aortic aneurysm, the aneu rysm ruptured during the waiting period in 6, and 4 of them died, for a com plication rate of 7% and a death rate of 5%. Two of the 6 aneurysms rupture d after the patient had waited longer than the target time. Three of 100 pa tients with symptomatic carotid artery stenosis awaiting admission for caro tid endarterectomy suffered ischemic stroke, for a 3% complication rate; al l had waited longer than the target period. One patient suffered occlusion of a femoropopliteal bypass graft while awaiting revision of a stenosed byp ass graft. CONCLUSIONS: This study suggests that although most patients are admitted f or operation within the benchmark time, one-third are admitted late and may suffer serious complications of their disease while awaiting admission for the procedure.