Prioritising the cardiac surgery waiting list: the angina patient's perspective.

Kee, Frank; McDonald, Paul T.; Gaffney, Brian

doi:10.1136/hrt.77.4.330

Cited by 11 publications

(14 citation statements)

References 10 publications

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“…Dissatisfaction with wait times for surgery has also been expressed by adults. 16,17 Our findings have important implications for physicians and policy-makers. They point out the high risk of hernia incarceration among infants and children less than 2 years of age while waiting for surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery

Zamakhshary¹,

To²,

Guan³

et al. 2008

Canadian Medical Association Journal

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Inguinal hernias in infants and young children are a result of a failure of the processus vaginalis to close. 1 Once diagnosed, an inguinal hernia should be promptly repaired on an elective basis to prevent the risk of hernia incarceration. Incarceration occurs in about 12% of infants and young children with an inguinal hernia. The incidence is highest (approaching 30%) among infants (< 1 year old). 2Boys who experience incarceration of an inguinal hernia have a 30% risk of testicular atrophy that may affect future fertility. 3Many countries are struggling with long wait times for elective surgical procedures. [4][5][6] To date, research has been skewed toward examining wait times for surgery and other medical or diagnostic care in adults.7-10 Prolonged wait times for surgery to repair hernias have not been associated with adverse outcomes in adults, 11 but the effect of prolonged wait times in children has not been well studied. 1,12 We conducted this study to examine the relation between wait times for elective surgery and the risk of incarceration of inguinal hernia in infants and young children. We also explored the relation between wait times and the use of emergency department services before surgery. Methods Study population and data sourcesWe used the Ontario Discharge Abstract Database to identify infants and young children who were waiting for surgery to repair an inguinal hernia. This database is maintained by the Canadian Institute for Health Information and contains data on all hospital admissions in Ontario.We included infants and children less than 2 years of age who had a diagnosis of inguinal hernia (International Classification of Diseases [ICD], 9th revision, code 550 or ICD, 10th revision, code K40) and a surgical procedure code for hernia repair (ICD, clinical modification, codes 53.0 to 53.9)

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Section: Discussionmentioning

confidence: 99%

Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery

Zamakhshary¹,

To²,

Guan³

et al. 2008

Canadian Medical Association Journal

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“…This concept of prioritisation is in essence the rationale behind triage, although the criteria to be used in prioritisation encompass more than simply the estimated risk of a waiting list related death 10. Clinicians use a set of guidelines to differentiate patients in greater medical need from those patients in less need 11…”

Section: Discussionmentioning

confidence: 99%

Death on the waiting list for cardiac surgery in the Netherlands in 1994 and 1995

Plomp¹,

Redekop²,

Dekker³

et al. 1999

Heart

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“…Here the rots curve could be used to infer a diagnostic threshold compatible with the maximal possible use of b, subject to the constraint. Examples of such rules already exist, notably in the area of access to surgery [30,31]. Our method shows how these rules could be formalised within cea, in relation to diagnostic tests.…”

Section: If More Than One Test Is Available Which Is Best?mentioning

confidence: 99%

The economics of diagnosis

2006

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Any population can be divided into two groups, one with the presence of a given disease or condition, and the other without. Diagnosis consists of using tests to sort the population into these groups. Diagnostic tests use a threshold value of a diagnostic variable to distinguish between disease-positive and disease-negative individuals. The analysis of error in diagnostic tests has typically been undertaken using receiver-operator characteristic (ROC) curves. More recently, economic value of information (VOI) methods have characterised the costs and consequences of testing. This paper develops a new method for economic test evaluation, which we call ROTS analysis. The ROTS curve plots the costs and effects of changing test thresholds, in cost-effectiveness space. We illustrate the use of our method with a worked example, and show how it can answer three key questions: (1) Is there any test that is worth doing? (2) What is a test's optimum operating point in terms of sensitivity and specificity? (3) If two tests are available, which is best? We contrast the merits of our method with those of established ROC and VOI analysis. We argue that ROTS analysis more clearly reveals the link between changing test thresholds and the cost-effectiveness of different treatments.

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Prioritising the cardiac surgery waiting list: the angina patient's perspective.

Cited by 11 publications

References 10 publications

Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery

Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery

Death on the waiting list for cardiac surgery in the Netherlands in 1994 and 1995

The economics of diagnosis

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