Delay to carotid endarterectomy in patients with symptomatic carotid artery stenosis.
OBJECTIVE
In patients with recently symptomatic carotid artery stenosis, guidelines recommend carotid revascularization within 2 weeks of the index event. The "index event" may be defined as either the first or the most recent event. The delay between the index event and carotid endarterectomy (CEA) over a period of 6 years in a single centre was evaluated and the effect of defining the index event as either the first or the most recent event was assessed.


METHODS
Observational study.


METHODS
555 consecutive patients with symptomatic carotid stenosis ≥ 50% treated with CEA between 2007 and 2012 were assessed. In 2010, changes to the in-hospital process of care to reduce delays in referral and CEA were introduced. These changes included, for example, improving access to physicians, imaging, and operating rooms. The delay from symptoms to surgery was expressed in days.


RESULTS
The median time between the first event and surgery was reduced from 53 days (interquartile range [IQR] 30-78) in 2007 to 21 days (IQR 12-45) in 2012, and between the most recent event and CEA from 45 days (IQR 28-67) to 17 days (IQR 9-28). Patients referred directly by their general practitioner more often underwent CEA within 2 weeks than patients referred by specialists from other hospitals. Compared to patients with transient ischaemic attack or ocular symptoms, patients with ischaemic stroke more often underwent CEA within 2 weeks.


CONCLUSIONS
A small change in the process of care significantly reduced the delay from the index event to CEA, but in 2012 it still exceeded 14 days in the majority of patients. The definition of the "index event" has a large impact on the total duration of delay, and should therefore be uniform across studies.
Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
A G
AG
den Hartog
Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
F L
FL
Moll
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
H B
HB
van der Worp
Department of Anesthesiology, University Medical Center Utrecht, The Netherlands.
R G
RG
Hoff
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
L J
LJ
Kappelle
Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: g.j.deborst-2@umcutrecht.nl.
G J
GJ
de Borst
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care / Q000592:standards; D013997:Time Factors
Carotid artery stenosis; Carotid endarterectomy; Symptomatic; Timing