title: Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences.
abstract: BACKGROUND
  Long waiting times for elective surgical treatment threaten timely care provision in several countries. The purpose of this study was to assess the impact of waiting for elective general surgery on the quality of life and psychosocial health of patients.
  
  
  METHODS
  A cross-sectional questionnaire study with postoperative follow-up was performed among patients on waiting lists for surgical treatment of varicose veins (n = 176), inguinal hernia (n = 201), and gallstones (n = 128) in 27 hospitals.
  
  
  RESULTS
  In each group the waiting period involved worse general health perceptions (GHPQ), more problems in quality of life (EuroQoL), and raised levels of anxiety (STAI) as compared to after surgery (all differences: p < 0.05). Quality of life was not affected in 19-36% of patients. Emotional reactions to waiting were most negative among patients with gallstones. Prior information about the duration of the wait reduced the negativity of these reactions (p < 0.05). Social activities were affected in 39% to 48% of the patients and 18%-23% of employed patients reported problems with work during the wait. Having waited a longer time was associated with worse quality of life among patients with inguinal hernia. Longer waited times also engendered more negative reactions to waiting among patients with inguinal hernia and gallstones (multilevel regression analysis, p < 0.01).
  
  
  CONCLUSIONS
  Waiting for general surgery mainly involves a prolonged period of decreased health and an affected psychological and social life of the patient in waiting. Variation in the severity of these consequences across patients indicates that the prioritisation of patients could reduce the overall burden of waiting. Early information about the duration of the delay could further promote a patient's acceptance of waiting.
authors.affiliation: Department of Public and Occupational Health, Institute for Research in Extramural Medicine, Free University Medical Centre, Amsterdam, The Netherlands. j.oudhoff@vumc.nl.
authors.forename: J P
authors.initials: JP
authors.lastname: Oudhoff
authors.forename: D R M
authors.initials: DR
authors.lastname: Timmermans
authors.forename: D L
authors.initials: DL
authors.lastname: Knol
authors.forename: A B
authors.initials: AB
authors.lastname: Bijnen
authors.forename: G
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D042882:Gallstones / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D006297:Health Services Accessibility; D006552:Hernia, Inguinal / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D011594:Psychometrics; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D013997:Time Factors; D014648:Varicose Veins / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D014850:Waiting Lists