WTP1.14 A Regional Audit of Carotid Endarterectomy Symptom to Surgery Target Times within the North-East of England

Abstract

Abstract Aim The National Institute of Health and Care Excellence (NICE) recommend a target time for symptomatic carotid stenosis symptom onset to surgery of 14-days so to minimise the chance of high-risk patients developing a major stroke. A regional audit of Vascular Units within the North-East of England to meet this target was undertaken to review performance and identify causes for delays. Methods The performance of three North-East based Vascular Units for the period of October 2021-March 2022 has been assessed retrospectively using Carotid Endarterectomy data from the National Vascular Registry (NVR). Data was collated and reviewed as per the distinct time phases in the CEA treatment pathway outlined in the NVR Annual Reports. Results 66 CEAs were performed, with the region achieving 45.45% within the 14-day target (median time from symptom onset to surgery 16 days; IQR 4-102). Patients referred to Vascular Surgery in <7 days of symptom onset was achieved in 69.70% of patients (median 4 days; IQR 0-56); patients receiving surgery within <7 days of the referral to Vascular Surgery was achieved in 25.76% of patients (median 11.5 days; IQR 0-82). Conclusion The North-East region is struggling to meet the 14-day symptom to CEA target. Understandably, there is variation in CEA pathway workings across the Units but improvements can be made regionally. A delay between patients being referred to Vascular Surgery and then receiving surgery accounts for the biggest delay. A questionnaire identifying possible barriers to meeting the 14-day target has been distributed amongst the region’s Vascular Consultants and Registrars with a view to improvements being made.