Published 4 June 2009, doi:10.1136/bmj.b1847
Cite this as: BMJ 2009;338:b1847

Research

Waiting times for carotid endarterectomy in UK: observational study

Alison W Halliday, professor of vascular surgical studies1, Tim Lees, consultant vascular surgeon2, Dora Kamugasha, research coordinator1, Robert Grant, medical statistician3, Alex Hoffman, national sentinel stroke audit programme manager3, Peter M Rothwell, professor of neurology4, John F Potter, professor of ageing and stroke medicine5, Michael Horrocks, professor of vascular surgery6, Ross Naylor, professor of vascular surgery7, Anthony G Rudd, consultant stroke physician8, on behalf of Carotid Endarterectomy Steering Group; Clinical Effectiveness and Evaluation Unit, Royal College of Physicians; Vascular Society of Great Britain and Ireland

1 St George’s, University of London, London SW17 0RE, 2 Freeman Hospital, Newcastle upon Tyne, 3 Royal College of Physicians, London, 4 John Radcliffe Hospital, Oxford, 5 School of Medicine, Health and Policy Practice, University of East Anglia, Norwich , 6 Royal United Hospitals, Bath, 7 Leicester Royal Infirmary, Leicester, 8 St Thomas’ Hospital, London

Correspondence to: A Halliday alisonhalliday{at}aol.com

Objectives To assess timeliness of carotid endarterectomy services in the United Kingdom.

Design Observational study with follow-up to March 2008.

Setting UK hospitals performing carotid endarterectomy.

Participants UK surgeons undertaking carotid endarterectomy from December 2005 to December 2007.

Main outcome measures Provision and speed of delivery of appropriate assessments of patients; carotid endarterectomy and operative mortality; 30 day postoperative mortality.

Results 240 (61% of those eligible) consultant surgeons took part from 102 (76%) hospitals and trusts. Of 9913 carotid endarterectomies recorded on hospital episode statistics, 5513 (56%) were included. Of the patients who underwent endarterectomy, 83% had a history of transient ischaemic attack or stroke. Of these recently symptomatic patients, 20% had their operation within two weeks of onset of symptoms and 30% waited more than 12 weeks. Operative mortality was 0.5% during the inpatient stay and 1.0% (95% confidence interval 0.7% to 1.3%) by 30 days.

Conclusion Only 20% of symptomatic patients had surgery within the two week target time set by the National Institute for Health and Clinical Excellence (NICE). Although operative mortality rates are comparable with those in other countries, some patients might experience disabling or fatal stroke while waiting for surgery and hence not be included in operative statistics. Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes.

© Halliday et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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