title: Surgical waiting times and patient choice: how much delay do patients really want?
abstract: BACKGROUND
  The 18-week target to treatment government initiative was implemented in 2004. In order for this to work, patients need to accept operative dates provided, otherwise the pathway will fail.
  
  
  OBJECTIVE
  The aim of this prospective study was to identify the earliest time patients would accept surgical intervention following assessment at an outpatient clinic and to identify the reasons why some patients would choose to delay surgery.
  
  
  METHODS
  This prospective study was carried out at an elective orthopaedic centre over a 5-month period. All new adult referrals to the department were asked to complete a seven-point questionnaire on waiting time preference and possible reasons for delaying surgery. No paediatric or spinal orthopaedics was carried out at the centre.
  
  
  RESULTS
  A total of 73 % of the 797 questionnaires were completed. Up to 16 % of patients could not accept day-case/inpatient operation within 6 weeks. Work commitment was the most common reason for choosing to delay surgery, with nearly 50 % of employed patients citing it as a reason. No significant difference was identified between inpatient and day-case procedures.
  
  
  CONCLUSIONS
  There is a risk that operative slots will be unfilled within the 18-week pathway. 18 % of patients will potentially refuse an operative date offered within 6 weeks of their outpatient visit. Work, holidays and care arrangements are important in uptake. A proactive strategy to improve the uptake of offered surgery is required to prevent operating slots being underutilised.
authors.affiliation: Musculoskeletal Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK, vchansrani@doctors.org.uk.
authors.forename: Vivak Chander
authors.initials: VC
authors.lastname: Hansrani
authors.forename: Angus
authors.initials: A
authors.lastname: Fong
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ferran
authors.forename: Stephen
authors.initials: S
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D004493:Education; D017558:Elective Surgical Procedures; D004651:Employment; D005260:Female; D006693:Holidays; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D057240:Patient Preference; D057805:Pets; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment; D055815:Young Adult
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