Delay In Surgical Treatment Research Articles

Plate osteosynthesis of humeral diaphyseal fractures associated with radial palsy: twenty cases.

Surgical management of humeral fractures associated with radial nerve palsy remains controversial. Some advocate surgical treatment in emergency while others recommend nonoperative treatment. The aim of the study was to assess nerve recovery in a series of patients treated with open reduction and internal fixation (ORIF) with plate for humeral fracture associated with radial nerve palsy. We hypothesised that surgical treatment with ORIF in emergency allows good nerve recovery. We conducted a retrospective study on 20 patients out of 225 humeral shaft fractures operated between 1995 and 2012. There were 11 women and nine men, with a mean age of 51 ± 22 years (23-93). The fractures were located in mid third of the shaft in 15 cases (75 %), distal third in four (20 %) and superior third in one (5 %). Mean delay for surgical treatment was three days (zero to 15). The plate was positioned at the medial face in 16 cases (80 %) and posterior face in four (20 %). In six cases, the radial nerve was not seen (30 %). In the 14 cases where it was seen (70 %), it was continuous. Neurolysis was performed in seven cases (35 %). Fifteen patients (75 %) had a good nerve palsy recovery, with a mean delay of ten months (six to 12). Statistically significant correlation was observed between delay of surgical treatment and delay of radial recovery (p = 0.0166 ; Rho = - 0.53). Early osteosynthesis was correlated with better nerve recovery. One patient required complementary nerve surgery and another tendon transfer. Bone healing was obtained in all cases. Concerning functional outcomes, mean QuickDASH, a shortened version of the Disabilities of the Arm, Shoulder and Hand (DASH) score, was 9 ± 17 (0-59), and 85 % of patients were able to recover their previous physical activities. ORIF by plate of humeral shaft fracture with radial nerve palsy in emergency allows good palsy recovery (75 %) with a short delay (about three days). Level IV, retrospective study.

346 Delay of surgical treatment of penile fracture results in poor functional outcome: Results from a large retrospective multicenter European study

346 Delay of surgical treatment of penile fracture results in poor functional outcome: Results from a large retrospective multicenter European study

2083278 Isolated Tubal Torsion; Review of 5 Cases

Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. We report 5 cases of isolated fallopian tube torsion in varying age group from adolescent girl to post menopausal women. We report 5 cases who presented with acute pelvic pain for ultrasound. One patient was premenarchal, two reproductive age group and two were post menopausal. Three patients gave H/O tubal ligation. All patient were scanned on philips HD11 color Doppler machine.Scanning was done transabdominally first with C2-5 convex transducer and then transvaginally using C8-4v endoluminal transducer. In one unmarried patient transrectal scanning was done. All patients showed convoluted, oval, tortuous, thick walled adnexal cystic lesion on the side of pain. There were internal echoes within. In three patients typical whirlpool sign was observed. All patients were operated and diagnosis of torsion was confirmed. Torsion of the tube without an ovarian torsion is termed as isolated fallopian tube torsion (IFTT). Isolated torsion of a fallopian tube can be precipitated by intrinsic and extrinsic etiologies. The intrinsic pathologies are pelvic inflammatory disease, hydrosalpinx, prior tubal surgery, and primary fallopian tube malignancy. The extrinsic pathologies are scarring from endometriosis, prior pelvic surgery, gravid uterus, malignancy or tumor of the adjacent structures, and paraovarian or paratubal cysts. The term “idiopathic”or primary torsion refers to the absence of the above mentioned precipitating etiologic factors. In our series three patients had intrinsic tubal factor (tubal ligation) whereas two patients had no obvious risk factor. Isolated tubal torsion should be included in the list of differential diagnoses of pelvicpain in women of any age group. Since the medical history and physical examination findings may not be suggestive, pelvic US is the modality of choice. In Correlation with clinical findings and using Ultrasonography criteria, one can make a specific diagnosis of tubal torsion and hence not requiring any further imaging modality to prove the same.

Diagnosis and surgical delays in African American and white women with early-stage breast cancer.

Delays in diagnosis and treatment for breast cancer may contribute to excess deaths among African Americans. We examined racial differences in delays in diagnosis and surgical treatment for early-stage breast cancer and evaluated race-specific predictors associated with delay. A retrospective cohort study was conducted among 634 African American and white women diagnosed with invasive breast cancer between 2005 and 2010 in New Jersey. Detailed medical-chart abstraction and patient interviews were undertaken. Time intervals were calculated from symptom recognition to diagnosis (diagnosis delay) and from diagnosis to first operation (surgical delay). Binomial regression models were used to examine racial differences in delay and factors associated with ≥2 months delay in the overall population and stratified by race. Reasons responsible for diagnosis delay were also examined by race. Compared to white women, African American women experienced significantly higher risk of ≥2 months delay in diagnosis and surgical treatment (adjusted relative risks=1.44 (1.12-1.86) and 3.08 (1.88-5.04), respectively). For the African Americans, predictors of diagnosis delay included mode of detection, insurance, and tumor size; for whites, mode of detection and tumor grade. Surgical delay was associated with operation type and education among African Americans but with operation type and tumor size for whites. Patient-related factors were commonly noted as reasons for diagnosis delay. These findings emphasize the need to raise further awareness, especially among African American patients and their providers, of the importance of prompt evaluation and treatment of breast abnormalities. Research on effective ways to accomplish this is needed.

Surgical Technique and Clinical Outcomes for Primary Intradural Extramedullary Spinal Tumors

Background: Primary intradural extramedullary spinal tumors are rare and comprise nerve sheath tumors, meningiomas, and other rare pathologies. Clinical symptoms of these tumors are often nonspecific and are usually not obvious until neurological deterioration occurs. A delay in surgical treatment can lead to permanent neurological deficits. The aim of this study is to assess the clinical manifestations and surgical results of patients diagnosed with primary intradural extramedullary spinal tumors. Methods: From September 1999 to June 2014, patients who underwent surgery for primary intradural extramedullary spinal tumors at the orthopedic departments of authors' institutes were included in this study. Surgical procedures included laminectomy and midline durotomy for adequate exposure, total excision of tumors, and primary closure of durotomy by non-absorbable sutures. Spinal instrumentation and fusion was performed to prevent postlaminectomy kyphosis in only one patient whose tumor located in upper thoracic spine. The data were gathered retrospectively from medical records and included clinical presentation, tumor location, histopathology, postoperative complications and outcomes. Results: There were 11 patients, 5 males and 6 females, included in this study. The mean age of the patients was 52.8 (between 25 and 75) years. Preoperative symptoms included back pain in all cases, Brown-Sequard syndrome in the 3 cases of thoracic lesions, and sciatica-type of symptoms in 8 cases of lumbar lesions. The histopathologic results were meningiomas for 2 cases, schwannomas for 6 cases, paraganglioma for 1 case, ependymoma for 1 case, and mesenchymal chondrosarcoma for 1 case. Meningiomas and mesenchymal chondrosarcoma were located in the thoracic spine. Three schwannomas located at the level of conus medullaris. Paraganglioma, ependymoma, and the other three schwannomas located at the level of cauda equina. The case of mesenchymal chondrosarcoma received radiotherapy after surgery for the malignant nature of the tumor. All patients recovered well from preoperative symptoms after surgery. Persistent CSF leakage needed revision of dural repair was noted in one case. Iatrogenic spondylolisthesis at the operated levels was noted in one case but the patient declined the suggestion of additional spinal fusion because the clinical symptoms were minimal. No recurrence of tumor was found in the follow-up period. Conclusion: Although malignant lesions have been reported sporadically in the literature, intradural extramedullary tumors are usually benign. There is no typical presentation of clinical symptoms, therefore early-stage intradural extramedullary tumors are difficult to detect. Complete excision of these tumors is usually achievable and the neurologic prognosis after surgical excision is often better than the other spinal neoplasia.

Reliability of the Laboratory Risk Indicator for Necrotizing Fasciitis (Lrinec) Score for Early Diagnosis of Necrotizing Fasciitis

Objective: Necrotizing fasciitis is a surgical emergency often requiring prompt diagnosis and treatment. Delay in surgical intervention can have catastrophic results including death. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score uses laboratory parameters to assess the severity of infection and helps in early recognition of necrotizing fasciitis. i?½In this study, we collected the data of 40 patients diagnosed and treated as necrotizing fasciitis to validate the reliability of this score in early diagnosis of necrotizing fasciitis. Materials and methods: This is a retrospective study. Data of 40 patients admitted to Fr. Muller Medical College Hospital, Mangalore from August, 2012 to August, 2014 with a clinical diagnosis of Necrotizing fasciitis was analyzed and relevant statistical tests were applied to evaluate the reliability of the LRINEC score. Results: A total of 40 patients were included in the study. A LRINEC score of > 6 had a sensitivity of i?½ 93.10 %, specificity of 90.91%, positive predictive value of 96.43%, and negative predictive value of 83.33%. The most common organism isolated on culture was Staphylococcus aureus. Conclusion: The LRINEC score is an impressive diagnostic tool to differentiate between necrotizing fasciitis and other less severe soft tissue infections. It aids in early recognition of necrotizing fasciitis enabling prompt and appropriate treatment.

Dependence for basic and instrumental activities of daily living after hip fractures

The objective of the study is to determine basic activities of daily living (Barthel Index) and instrumental activities of daily living (Lawton-Brody Index) before and after hip fracture. Follow-up study of patients (n=100) with hip fracture, operated at Complejo Hospitalario Universitario de A Coruña (Spain). Period January/2009–December/2011. Demographic characteristic of the patients, Charlson Index, Glomerular filtration rate, Barthel index, Lawton index, type of proximal femur fracture and surgical treatment delay were recorded. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Before fracture were independent for activities of daily living (ADL) a 38.0%, at 90 days were 15.4%. The Barthel index score decreased from 75.2±28.2 to 56.5±31.8) (p<0.0001). If we consider the age, gender, comorbidity (Charlson index), renal function, fracture type and surgical delay objectify the only independent variable to predict dependency effect is age. If we also consider the Barthel score objectify the variable that significantly modifies that score at 90 days is the baseline value of the index. The prevalence of independence for instrumental activities of daily living (IADL) at the baseline moment is 11% and at 90 days is decreased to 2.2%. There is a decrease in the independence effect in all activities. The variable predictor of independence for all activities after taking into consideration age, sex, comorbidity, fracture type, surgical delay and renal function is the baseline score of the Barthel and Lawton index.

Understanding process-of-care delays in surgical treatment of breast cancer at a comprehensive cancer center.

Few studies have examined care processes within providers' and institutions' control that expedite or delay care. The authors investigated the timeliness of breast cancer care at a comprehensive cancer center, focusing on factors influencing the time from initial consultation to first definitive surgery (FDS). The care of 1,461 women with breast cancer who underwent surgery at Dana-Farber/Brigham and Women's Cancer Center from 2011 to 2013 was studied. The interval between consultation and FDS was calculated to identify variation in timeliness of care based on procedure, provider, and patients' sociodemographic characteristics. Targets of 14days for lumpectomy and mastectomy and 28days from mastectomy with immediate reconstruction were set and used to define delay. Mean days between consultation and FDS was 21.6 (range 1-175, sd 15.8) for lumpectomy, 36.7 (5-230, 29.1) for mastectomy, and 37.5 (7-111, 16) for mastectomy with reconstruction. Patients under 40 were less likely to be delayed (OR=0.56, 95% CI=0.33-0.94, p=0.03). Patients undergoing mastectomy alone (OR=2.64, 95% CI=1.80-3.89, p<0.0001) and mastectomy with immediate reconstruction (OR=1.34 95% CI=1.00-1.79, p=0.05) were more likely to be delayed when compared to lumpectomy. Substantial variation in surgical timeliness was identified. This study provides insight into targets for improvement including better coordination with plastic surgery and streamlining pre-operative testing. Cancer centers may consider investing in efforts to measure and improve the timeliness of cancer care.

Variations in time to receiving first surgical treatment for breast cancer as a function of racial/ethnic background: a cohort study.

ObjectiveTo evaluate surgical treatment delay disparities by race/ethnic group in a group of breast cancer patients treated in the New York region.DesignCohort study.SettingTwo affiliated hospitals in the New York region.ParticipantsPatients admitted at two affiliated hospitals in the New York region for breast cancer treatment during 2007–2011.Main outcome measureTime to receiving first surgery for breast cancer, defined as the time in days between initial diagnosis (biopsy) and definitive surgical treatment (lumpectomy or mastectomy). Predicted time to first surgery by race group was also analysed using a multivariate linear regression model with adjustments made for several demographic and clinical factors.ResultsTotally, 3071 patients who were first treated with surgery were identified. Racial background was classified as White, African American or Asian/other. Overall median time to surgery was 28 days: 28 days in whites, and 34 and 29 days in African Americans and Asian/others, respectively (p = 0.032). Multivariate analyses showed that only African Americans, not Asian/others, had significantly increased surgical delay compared to whites (p = 0.019).ConclusionsThis study demonstrates significant racial differences in surgical delay in a group of breast cancer patients treated in the New York region. These differences may reflect tacit attitudes of medical providers or processes insensitive to patient educational needs. Additional studies may improve our understanding of this delay.

Operative Treatment of Type II Supracondylar Humerus Fractures

Because of the changing referral patterns, operative pediatric supracondylar humerus fractures are increasingly being treated at tertiary referral centers. To expedite patient flow, type II fractures are sometimes pinned in a delayed manner. We sought to determine if delay in surgical treatment of modified Gartland type II supracondylar humerus fractures would affect the rate of complications following closed reduction and percutaneous pinning. We performed a retrospective review of a consecutive series of 399 modified Gartland type II supracondylar fractures treated operatively at a tertiary referral center over 4 years. Mean patient age in the type II group was 5 years (range, 1 to 15 y). A total of 48% were pinned within 24 hours, 52% pinned >24 hours after the injury. No difference was in detected in rates of major complications between the early and delayed treatment group. Four percent of patients sustained a complication (16 patients). There were no compartment syndromes, vascular injuries, or permanent nerve injuries. Complications included nerve injury (3), physical therapy referral for stiffness (3), pin site infection (2 treated with oral antibiotics, 4 treated with debridement), refracture (2), and loss of fixation or broken hardware (2). Of the 3 patients who sustained nerve injuries, all underwent surgery within 24 hours of injury. One patient developed an ulnar motor and sensory nerve palsy after fixation with crossed K-wires. This resolved by 7 weeks postoperatively. Two patients presented with an anterior interosseous nerve palsy-1 resolved 1 week after surgery, the other by 8 weeks postoperatively. Delay in surgery did not result in an increased rate of major complications following closed reduction and percutaneous pinning of type II supracondylar humerus fractures in children. Further prospective work is necessary to determine if there are subtle treatment benefits from emergent treatment of type II supracondylar humerus fractures. Level III-retrospective comparative series.

Disparities in breast cancer surgery: The lingering effect of race.

6576 Background: Stage migration may be associated with delays in surgical breast cancer treatment >90 days. Although it is not recommended to have a 3-month span from diagnosis to definitive surgi...

Abstract 486: The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms

The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms Objective: Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiting such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends as compared to patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic and abdominal aortic aneurysm and elucidate the possible reasons. Methods: Using the Nationwide Inpatient Sample (NIS), a publicly available database of inpatient care, we analyzed the incidence of mortality among patients admitted on the weekends compared to weekdays for ruptured aortic aneurysm. Ultimately the care of over 7,000 patients was analyzed for the primary endpoints. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention and use of additional therapeutic measures. Results: Patients admitted on the weekend for both ruptured thoracic and abdominal aortic aneurysm had a statistically significant increase in mortality as compared to those admitted on the weekdays (OR 2.55 for Thoracic and 1.32 for Abdominal). By our analysis this is likely due to a delay in surgical care on the weekends. Conclusions: Weekend admission for ruptured aortic aneurysm is associated with an increased mortality when compared to those admitted on the weekend and this is likely due to several factors with the most predominant being a delay in surgical intervention.

Delay in surgical treatment of patients with hilar cholangiocarcinoma: does time impact outcomes?

BackgroundSubstantial time elapses before patients with hilar cholangiocarcinoma (HCC) receive surgical treatment because of time-consuming preoperative staging and other interventions, including biliary drainage and portal vein embolization. Prolonged times potentially lead to unresectability and the formation of metastases, yet these issues have not been investigated previously in HCC. This study aimed to evaluate the time between onset of symptoms and the provision of ultimate treatment in patients with HCC and the impact of the length of time on outcomes. MethodsDelays in the treatment of consecutive patients with HCC were evaluated by contacting general practitioners (GPs) and extracting data from hospital files. Time periods were correlated with resectability, occurrence of metastasis, tumour stage and survival using logistic and Cox regression analyses. ResultsTreatment times in 209 consecutive HCC patients were evaluated. The median time from first GP visit until presentation at the tertiary centre was 35 days. Time until treatment was longer when initial symptoms did not include jaundice (non-specific symptoms, P < 0.001). Duration of workup and preoperative biliary drainage at the tertiary centre prior to final surgical treatment resulted in an additional median time of 74 days. No correlation was found between treatment time in weeks and resectability [odds ratio (OR) 1.010, 95% confidence interval (CI) 0.985–1.036], metastasis (OR = 0.947, 95% CI 0.897–1.000), tumour stage (OR = 1.006, 95% CI 0.981–1.031) or survival in resected patients (hazard ratio = 0.996, 95% CI 0.975–1.018). ConclusionsThe time that elapses between the presentation of symptoms and final treatment in patients with HCC is substantial, especially in patients with non-specific symptoms. This time, however, does not affect resectability, metastasis, tumour stage or survival, which suggests that preoperative optimization should not be omitted because of potential delays in treatment.

Su1789 Effect of Delay in Surgical Treatment of Colon Cancer on Survival

Su1789 Effect of Delay in Surgical Treatment of Colon Cancer on Survival

Treatment delay for Māori women with breast cancer in New Zealand

Objectives. To identify differences in delay for surgical treatment of breast cancer between ethnic groups and to evaluate the role of health system, sociodemographic and tumour factors in ethnic inequities in breast cancer treatment.Methods. A retrospective analysis of prospectively collected data from the Waikato Breast Cancer Register for cancers diagnosed in the Waikato region in New Zealand (NZ) from 1 January 2005 to 31 December 2010.Results. Approximately 95% (1449 out of 1514) of women with breast cancer diagnosed in the Waikato over the study period were included. Of women undergoing primary surgery (n = 1264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis, respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among Māori (mean = 37.1 days, p = 0.005) and Pacific women (mean = 42.8 days, p = 0.005). Māori women were more likely to experience delays longer than 31 (p = 0.048) and 90 days (p = 0.286) compared with NZ European women. Factors predicting delays longer than 31 and 90 days in the multivariable model included public sector treatment (OR 5.93, 8.14), DCIS (OR 1.53, 3.17), mastectomy (OR 1.75, 6.60), higher co-morbidity score (OR 2.02, 1.02) and earlier year of diagnosis (OR 1.21, 1.03). Inequities in delay between Māori and NZ European women were greatest for women under 50 years and those older than 70 years.Conclusion. This study shows that significant inequities in timely access to surgical treatment for breast cancer exist in NZ, with Māori and Pacific women having to wait longer to access treatment than NZ European women. Overall, a high proportion of women did not receive surgical treatment for breast cancer within the guideline limit of 31 days. Urgent steps are needed to reduce ethnic inequities in timely access to breast cancer treatment, and to shorten treatment delays in the public sector for all women.

Effect of Optical Coherence Tomography Scan Pattern and Density on the Detection of Full-Thickness Macular Holes

To evaluate the impact of different scan patterns and scan densities on small full-thickness macular hole (MH) detection. Retrospective cross-sectional analysis. Analysis was performed on 25 eyes from 24 patients with full-thickness MHs imaged with the Heidelberg Spectralis HRA+OCT. Included eyes underwent concurrent imaging with a standard (61-line) raster volume and a 24-line radial pattern. A 6-line radial scan pattern was extrapolated from the higher-density radial pattern. Comparisons of the missed hole rate as well as the proportion of individual B-scans demonstrating a full-thickness defect (termed "full-thickness detection index") were carried out for the 3 scan patterns. Additionally, qualitative and quantitative hole parameters were evaluated to identify factors associated with "missed" holes. Full-thickness defects were missed at substantially higher rates using both standard raster volume (20.0%, 90% confidence interval [CI] 8.2%-37.5%) and 6-line radial scanning (12.0%, 90% CI 3.7%-30.4%) when compared to 24-line radial scanning (0% for both comparisons). Full-thickness detection indices were significantly higher for both radial scan patterns when compared to raster scanning (P < .001 for both comparisons). Missed holes were smaller and commonly associated with prehole flaps. High-density radial scanning demonstrated superior detection rates of small full-thickness MHs compared to standard raster volume scanning. This finding may be attributable to the greater foveolar scan density attained with radial scan patterns. Failure to utilize radial scanning in the setting of suspected macular holes may lead to a delay in surgical treatment, with attendant worse anatomic and visual outcomes.

Predictors of Delay of Surgical Intervention in Patients with Hepatocellular Carcinoma

Predictors of Delay of Surgical Intervention in Patients with Hepatocellular Carcinoma

Irrigation and Debridement

Irrigation and Debridement

Early Diagnosis of Necrotizing Fasciitis of Unknown Origin: A Challenge to Prevent the Delay of Surgical Treatment

Cervical Necrotizing Fasciitis is an uncommon infection. It is characterised by a rapidly progressive polymicrobial infection that spreads along the deep fascial planes of the neck. Its fulminant course and high morality makes this disease a diagnostic challenge for the maxillofacial surgeon. Therefore, when clear clinical signs and suspicious images are available, the patient must be taken to the operating room for surgical treatment. Although it is considered a rare entity, misdiagnosis is not acceptable due to its fatal outcome. Close physical examination with a thorough medical history may set the alarm. Further medical test will help to achieve the diagnosis, but never should delay the start of the appropriate treatment. We present a case of cervical necrotizing fasciitis of unknown origin successfully managed in our department. Odontogenic infection and less frequently tonsilar infections are the origin of this infection. Nevertheless, just an auricular wound could be identified as a possible source of this cervical necrotizing fasciitis. We believe that the aggressive surgical treatment combined with broad-spectrum antibiotic and intensive medical care was the key of the early recovery and few after-effects. The aim of this article is to insist in the weigh of the maxillofacial surgeon on the early surgical treatment of the cervical necrotizing fasciitis.

Abstract P5-13-15: Process-of-care: Elucidating delays in surgical treatment of breast cancer

Abstract Background: We examined the timeliness of breast cancer care at our cancer center, focusing on care processes that affect the time from surgical consultation to surgery, with the goal of identifying improvement opportunities. Methods: We studied 584 women who underwent a mastectomy (with or without reconstruction) or breast conserving therapy at one of two Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) surgical sites between Jan. 1, 2011 and Feb. 28, 2012. We excluded patients who received a DF/BWCC consultation but received surgery elsewhere, those who required neo-adjuvant chemotherapy, and patients whose surgeons had no primary appointment at DF/BWCC. We calculated the delay between consultation and surgery, defined as an interval of greater than two weeks for cases of mastectomy without reconstruction or breast conserving therapy, and four weeks for those with mastectomy with immediate reconstruction. We tabulated the number of patients with a delay, stratified by type of procedure and patient characteristics. We examined factors associated with a delay in bivariate analyses using Chi-square and multivariate logistic regression models with two-tailed tests and p&amp;lt;0.05. We examined provider-level variation in a subset of reconstructive surgery cases, and reviewed medical records of 50 patients with the greatest delays. Results. The mean number of days from consultation to surgery was 21 (range 2-104, SD 14) for lumpectomy, 31 (5-230, 28) for mastectomy, and 41 (6-180, 26) for mastectomy with reconstruction. Of women undergoing breast conserving therapy or mastectomy without reconstruction, 296 (67%) experienced a delay compared to 102 (71%) undergoing mastectomy with immediate reconstruction. Although no statistically significant findings were obtained in the bivariate analyses, age over 60 was associated with a two-fold delay in the multivariable model. Delays were also more likely among mastectomy procedures compared to breast conserving therapy. TableCharacteristicsNo Delay (n = 186)Delay (n = 398)OR (95% CI) No. (%)No. (%) Age 70-9528 (15)69 (17)2.6 (1.3-5.5)60-6943 (23)107 (27)2.0 (1.2-3.6)50-5951 (27)103 (26)1.3 (0.8-2.0)18-4964 (34)119 (30)1.0Race Non-White21 (11)43 (11)1.0 (0.6-1.9)White161 (89)346 (89)1.0Missing49 Primary Language Non-English7 (4)14 (4)1.0 (0.4-2.9)English179 (96)384 (97)1.0Insurance Medicare49 (26.3)97 (24)0.6 (0.3-1.0)Medicaid6 (3)8 (2)0.6 (0.2-1.7)Private131 (70)292 (74)1.0Missing01 Procedure Mastectomy with Recon41 (22)102 (26)1.6 (1.0-2.5)Mastectomy without Recon15 (8.1)53 (13)1.9 (1.0-3.6)Lumpectomy130 (70)243 (61)1.0 The 4 highest-volume breast surgeons (n&amp;gt;20 procedures each) varied in the time from initial consultation to plastic surgery consultation, from a mean of 7 to 22 days. Early screening and referral practices accounted for much of this variation. Delayed surgeries among the 50 patients with delays of at least 45 days included the need for additional testing or imaging, pre-operative medical evaluation, or “personal” reasons. Conclusion. Analyses of the interval from consultation to breast surgery identified process variation that may be amenable to improvement initiatives. Cancer centers should invest in efforts to measure, monitor, and improve the timeliness of breast cancer care. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-15.