title: A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis.
abstract: BACKGROUND
  Administrative wait times reflect the time from the decision to treat until surgery; however, this does not reflect the total time a patient actually waits for treatment. Several factors may prolong the wait for colon cancer surgery. We sought to analyze the time from the date of surgical consultation to the date of surgery and any events within this time frame that may extend wait times.
  
  
  METHODS
  We retrospectively reviewed the cases of all adult patients in Ontario aged 18-80 years with diagnosed colon cancer who did not receive neoadjuvant therapy and underwent resection electively between Jan. 1, 2002, and Dec. 31, 2009. Wait times were measured from the date of surgical consultation to the date of surgery. We chose a wait time of 28 days, reflecting local administrative targets, as a comparative benchmark. We performed univariate and multivariate analyses to identify variables contributing to a waits longer than 28 days. Variables were analyzed in continuous linear and logistic regression models.
  
  
  RESULTS
  We included 10 223 patients in our study. The median wait time from initial surgical consultation to resection was 31 (range 0-182) days. Age older than 65 years had a negative impact on wait time. Preoperative services, including computed tomography, cardiac consultation, echocardiography, multigated acquisition scan, magnetic resonance imaging, colonoscopy and cardiac catheterization also significantly increased wait times. Wait times were longer in rural hospitals.
  
  
  CONCLUSIONS
  Preoperative services significantly increased wait times between initial surgical consultation and surgery.
authors.affiliation: The Department of Surgery, Trinity College School of Medicine, Dublin, Ireland.
authors.forename: Amy
authors.initials: A
authors.lastname: Gillis
authors.affiliation: The Sunnybrook Research Institute, Toronto, Ont. and the Department of Surgery, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dixon
authors.affiliation: The Department of Surgery, University of Toronto, Toronto, Ont.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: The Sunnybrook Research Institute and the Department of Surgery, University of Toronto, Toronto, Ont.
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.affiliation: The Sunnybrook Research Institute, Toronto, Ont., the Department of Surgery, University of Toronto, Toronto, Ont., and the Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018802:Patient-Centered Care / Q000458:organization & administration*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists; D055815:Young Adult