Waiting times for carotid endarterectomy in UK: observational studyBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1847 (Published 04 June 2009) Cite this as: BMJ 2009;338:b1847
- 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
- 1St George’s, University of London, London SW17 0RE
- 2Freeman Hospital, Newcastle upon Tyne
- 3Royal College of Physicians, London
- 4John Radcliffe Hospital, Oxford
- 5School of Medicine, Health and Policy Practice, University of East Anglia, Norwich
- 6Royal United Hospitals, Bath
- 7Leicester Royal Infirmary, Leicester
- 8St Thomas’ Hospital, London
- Correspondence to: A Halliday
- Accepted 18 January 2009
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.
The large number of cases collected is a tribute to the hard work and dedication of the surgeons and their teams in submitting data. We thank Professor Walter Holland who encouraged us and the Stroke Association and the Chest, Heart and Stroke Association of Northern Ireland who sponsored the pilot study.
Contributors: AWH and DK carried out the pilot study. All authors as members of the Carotid Endarterectomy Steering Group were responsible for the design and execution of the study, DK was responsible for data collection and RG for data analysis. AWH is guarantor.
Funding: This study was funded by the Healthcare Commission (now Healthcare Quality Improvement Partnership), and the Vascular Society of Great Britain and Ireland (VSGBI) contributed to the funding of the web-based data collection tool. The authors are independent of the funders.
Competing interests: None declared.
Ethical approval: Not required.
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