Abstract

RODRIGUES, Gonçalo Manuel Baptista et al. Time Delays on Carotid Endarterectomy: institutional experience and improvement strategies. Angiol Cir Vasc [online]. 2016, vol.12, n.2, pp.85-92. ISSN 1646-706X.  https://doi.org/10.1016/j.ancv.2015.07.004.

Goals: Examine the referral process of patients with symptomatic carotid stenosis submitted to carotid endarterectomy in our institution; organize and analyse wait times since the index ischemic event to carotid surgery; identify reasons for delays and create improvement strategies. Methods: We conducted a retrospective study of all patients with symptomatic carotid stenosis submitted to carotid endarterectomy between 2011 and 2013 in our institution. The milestones of the referral process were noted and the date of symptom onset, first medical contact, vascular imaging, referral to and evaluation by vascular surgery, and carotid endarterectomy were recorded. The length of time between each milestone was calculated and reasons for delays were analysed. Results: Median time from index ischemic event to carotid endarterectomy was 27.5 days (range 7-581). The largest wait time intervals occurred between vascular surgical assessment and carotid endarterectomy (median of 9 days; range 1-349); between referral to vascular surgery and completion of vascular surgical assessment (median of 6.5 days; range 0-97) and between the first medical contact and completion of vascular imaging (median of 6 days; range 1-71). A total 60 patients were included. Only 21.7% received carotid endarterectomy within the recommended 14 days. Inpatient referral was associated with a shorter delay to carotid endarterectomy (n = 30; median 15 days, range 7-163) comparing to outpatient referral (n = 30; median 86 days, range 13-581) (p < 0.0001). Discussion: Although current evidence, delays in carotid endarterectomy are still meaningful. Strategies to reduce these delays are needed in order to ensure that a greater proportion of patients with symptomatic carotid disease receive carotid endarterectomy within the recommended 14 days from the index ischemic event.

Keywords : Wait times; Delay; Ischemic event; Carotid endarterectomy; Improvement strategies.

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