Improving the provision of carotid endarterectomy in line with UK Government targets requires more than just motivated surgeons

Ann R Coll Surg Engl. 2009 May;91(4):326-9. doi: 10.1308/003588409X391712. Epub 2009 Apr 2.

Abstract

Introduction: Carotid endarterectomy confers maximum benefit in symptomatic patients provided it is performed within < 2 weeks of presentation, but few centres achieve this target. The objective of this study was to determine if a surgeon with an interest in carotid endarterectomy could make simple modifications to practice so that carotid endarterectomy was performed within 2 weeks of referral in the majority of patients.

Patients and methods: Audit of 44 symptomatic patients undergoing carotid endarterectomy by one surgeon in 2007 after implementing simple changes in practice (e.g. ad hoc cancellation of non-urgent cases, ad hoc utilisation of cancelled theatre sessions). Outcomes were compared with 36 symptomatic patients undergoing carotid endarterectomy in 2006.

Results: There was only a modest reduction in delay to surgery. In 2006, 11% underwent carotid endarterectomy within 2 weeks of referral increasing to 20% in 2007. By 2007, 48% underwent surgery within 4 weeks compared with 33% in 2006.

Conclusions: Notwithstanding the additional impact of delays from symptom onset to referral, achieving a 2-week target will require more than motivated surgeons making simple changes to practice. It seems inevitable that vascular units will have to identify 1-2 'ring fenced' theatre sessions per week (but some could go unused) and surgeons will have to accept that they may not always operate on the patients they work-up.

Publication types

  • Comparative Study

MeSH terms

  • Delivery of Health Care / standards*
  • Endarterectomy, Carotid / standards*
  • England
  • Health Policy
  • Humans
  • Ischemic Attack, Transient / prevention & control
  • Medical Audit
  • Referral and Consultation / organization & administration
  • Referral and Consultation / standards
  • Stroke / prevention & control
  • Waiting Lists