An institutional study of time delays for symptomatic carotid endarterectomy

Charbonneau, Philippe; Bonaventure, Paule Lessard; Drudi, Laura M.; Beaudoin, Nathalie; Blair, Jean-François; Elkouri, Stéphane

doi:10.1016/j.jvs.2016.06.100

Cited by 8 publications

(11 citation statements)

References 22 publications

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“…Collaboration with the Ophthalmology and Neurology departments to facilitate urgent GP referrals and review of potential candidates for CEA would be crucial in reducing this source of delay. These were consistent with the findings of other international studies of a similar nature …”

Section: Discussionsupporting

confidence: 93%

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Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit

Lim

Laws

Beresford

et al. 2020

ANZ Journal of Surgery

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Background For patients presenting with symptomatic internal carotid artery stenosis, carotid endarterectomy (CEA) surgery is recommended to be performed generally within a 48‐hr to 14‐day window. This study aimed to assess timeliness of delivery, and outcomes, of CEA surgery in a tertiary vascular centre. Method Patients with symptomatic internal carotid artery stenosis who underwent CEA between 1 June 2014 and 31 June 2017 were identified and data were obtained from hospital records. The timeline of their journey from presentation to surgery was then mapped together with their outcomes. Results One hundred and seventy‐two cases were included in the study. Overall, the median time from development of presenting symptoms to surgery was 9 days and 119 (69%) cases were operated on within 14 days. The median time from development of presenting symptoms to ultrasound imaging was 2 days and the median time from symptoms to vascular referral was also 2 days. There were no deaths, strokes or transient ischaemic attacks within 30 days of CEA. At 1 year, survival was 100% but 15 (8.7%) had experienced at least one transient ischaemic attack or stroke. In the 53 cases operated upon beyond 14 days the dominant cause of delay in 32 (60%) was accessing surgery after review by the vascular service. Conclusion The aim of delivering CEA within 14 days of developing relevant symptoms was achieved in most cases with good outcomes. Nevertheless, points of delay in the patient journey that could be targeted for future quality improvement were identified.

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Section: Discussionsupporting

confidence: 93%

“…These were consistent with the findings of other international studies of a similar nature. [7][8][9][10] The delay in accessing surgery after assessment by the vascular service is of particular concern and amenable to improvement. The factors contributing to this delay can be divided into departmental resources, timing and patient factors.…”

Section: Discussionmentioning

confidence: 99%

Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit

Lim

Laws

Beresford

et al. 2020

ANZ Journal of Surgery

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“…Three Canadian studies have found that median delay to surgery from symptom onset varies from 25 to 79 days. 2,5,6 Similar trends are observed in Europe with median times to surgery ranging from 53 to 82 days. [7][8][9][10] Furthermore, studies have found that inpatients undergo carotid endarterectomy (CEA) more quickly with 54% receiving CEA within two weeks vs 20% compared to outpatients.…”

Section: How Does This Improve Population Health?supporting

confidence: 66%

“…[7][8][9][10] Furthermore, studies have found that inpatients undergo carotid endarterectomy (CEA) more quickly with 54% receiving CEA within two weeks vs 20% compared to outpatients. 6 The longest delay in care in one study was found to occur between symptom onset and vascular referral, which included delays to obtaining imaging given wait times for outpatient studies. 5 In a second study, time to carotid imaging was the major factor determining time to revascularization.…”

Section: How Does This Improve Population Health?mentioning

confidence: 97%

Can Emergency Physicians Perform Carotid Artery Point-of-Care Ultrasound to Detect Stenosis in Patients with TIA and Stroke? A Pilot Study

Suttie

Woo

Park

et al. 2020

WestJEM

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“…11,12,17 Both the current study and that of Jetty and colleagues 11 revealed that delayed patient presentation, diagnosis and referral are significant factors resulting in a delay in definitive care. In both studies, patients with amaurosis fugax were less likely to meet the guideline, and those who presented to the emergency department were the most likely to meet the guideline.…”

Section: Openmentioning

confidence: 53%

Factors associated with delay in carotid endarterectomy for patients with symptomatic severe internal carotid artery stenosis: a case–control study

Meyer

Karreman

Kopriva³

2018

cmajo

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Background:The Canadian Best Practice Recommendations for Stroke Care (2008 update) recommend that patients with neurologic symptoms secondary to severe internal carotid artery stenosis undergo carotid endarterectomy within 14 days of symptom onset to prevent stroke. The purpose of this study was to identify patient and system factors associated with meeting, or failing to meet, the guideline. Methods:In this case-control study, potential study participants were identified through an electronic search of the Discharge Abstract Database. We reviewed the charts of patients who presented to our centre with neurologic symptoms ipsilateral to internal carotid artery stenosis of 70%-99% and underwent carotid endarterectomy in our centre between Jan. 1, 2009, and Dec. 31, 2014. We performed logistic regression analysis to identify factors associated with meeting, or failing to meet, the guideline. Results:Of the 412 patients who underwent carotid endarterectomy during the study period, 219 met the inclusion criteria. Sixtyseven patients (30.6%) met the 14-day guideline. Thirty (14.2%) of the 212 patients who could be classified as case or control subjects did not access the health care system within 14 days. Once in the health care system, failure to meet the guideline was associated with a presentation of amaurosis fugax (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.05-0.96 compared to completed minor stroke) and presentation to a nonemergency outpatient setting (OR 9.08, 95% CI 2.51-32.80 compared to emergency department).Interpretation: Improvements in meeting the goal of carotid endarterectomy within 14 days of symptom onset for severe internal carotid artery stenosis should be directed at patient and system factors. A system for rapid diagnosis and referral of symptomatic patients to an appropriate surgeon should be established. Abstract Research E212CMAJ OPEN, 6(2)

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An institutional study of time delays for symptomatic carotid endarterectomy

Abstract: The majority of our cohort falls short of the recommended 2-week interval to perform CEA. Factors contributing to reduced CEA delay were presentation to an emergency department, in-patient investigations, and a stroke center where a vascular surgeon is available.

Cited by 8 publications

References 22 publications

Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit

Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit

Can Emergency Physicians Perform Carotid Artery Point-of-Care Ultrasound to Detect Stenosis in Patients with TIA and Stroke? A Pilot Study

Factors associated with delay in carotid endarterectomy for patients with symptomatic severe internal carotid artery stenosis: a case–control study

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