Waiting Time For Surgery Research Articles

BN SO23 - From referral to resolution, impact of acute biliary pathway on patients care

Abstract Background At our trust, we introduced acute biliary pathway to efficiently manage patients presenting with acute biliary pathology. This pathway begins with a referral form containing relevant patient information for triage. A triage team reviews these forms and classifies patients into three categories based on specific criteria. Method Patients are triaged into three categories:Red: Patients needing emergency surgery during the same admission.Amber: Patients requiring urgent but non-emergency care, scheduled for an outpatient (OP) appointment for consent, followed by a laparoscopic cholecystectomy within 2-3 weeks or 6-8 weeks, based on the pathology.Green: Patients who do not meet the criteria for red or amber are referred for further outpatient assessment before definitive management. Results Over four months , 202 referrals were received. Approximately 50% (102 patients) were referred to the outpatient department. Of the remainder, 45% were categorised as red and had IP cholecystectomy, with a mean length of stay of 1.5 days post-surgery across 30 operations. The remaining patients were managed as amber, resulting in 22 operations. The total complication rate was low, with only 2 cases managed conservatively, and 4 patients required re-admission before definitive treatment. The average wait time for a clinic appointment was 2 weeks, while the average wait time for surgery was 8 weeks, with a total of 6 cancellations. Conclusion The acute biliary pathway demonstrates effectiveness through a low complication rate and timely management of patients. This approach improves the efficiency of patient care and reduces the need for emergency re-admissions. More importantly, this model is straightforward enough to be implemented in any high-volume centre with a sufficient level of expertise in treating biliary patients.

An analysis into the rise of private healthcare in England by geographical location and time period

Abstract Background Private healthcare is a rapidly growing industry in the UK, particularly for surgical procedures. Across the pandemic period, waiting lists for elective surgical and consultant-led care increased from 4.4 to 7.5 million patients. This study aimed to analyse the trends and geographical variations in privately funded and NHS-funded orthopaedic private procedures across England compared to NHS waiting times. Methods We conducted a longitudinal study using quarterly national data between 2019 and 2023 in England. Descriptive analysis of quarterly orthopaedic surgical volumes per 10,000 people, and quarterly orthopaedic surgery wait times stratified by geographical location and time period was conducted. Results Between 2019 and 2023 there were a total of 1,469,450 procedures across the private sector, comprising 1,030,095 NHS-commissioned private orthopaedic procedures and 439,355 private orthopaedic procedures. The South of England performed a higher total number of private procedures per year compared to the North (63 vs 57/10,000 people); whilst there was almost double the number of privately funded procedures (23 vs 12/10,000), the difference was less amongst NHS-funded procedures (45 vs 40/10,000 respectively). There was a large variation in the number of NHS-funded procedures per 10,000 between regions. The North has consistently shorter waiting times than the South. Conclusions Our findings indicate considerable geographical variation in the use of private healthcare between regions, suggesting a two-tier healthcare system. The founding principles of the NHS, healthcare free at the point of use based on clinical need irrespective of ability to pay, continue to be eroded. Policy makers and politicians urgently need to find solutions to ensure all members of society can access the same high quality health care. Key messages • Private healthcare utilization in the UK for orthopaedic procedures, has increased significantly, contributing to an emerging two-tier healthcare system. • There are large geographical disparities in access to healthcare services, with he South of England performing more private proceeds with longer NHS waiting times compared to the North.

The Influence of Wait Time on Surgical Outcomes in Elective Lumbar Degenerative Spine Conditions: A Retrospective Multicentre Cohort Study.

Retrospective cohort study. The impact of delayed access to operative treatment on patient reported outcomes (PROs) for lumbar degenerative conditions remains unclear. The goal of this study is to evaluate the association between wait times for elective lumbar spine surgery and post-operative PROs. This study is a retrospective analysis of patients surgically treated for a degenerative lumbar conditions. Wait times were calculated from primary care referral to surgery, termed the cumulative wait time (CWT). CWT benchmarks were created at 3, 6 and 12months. A multivariable logistic regression model was used to measure the associations between CWT and meeting the minimally clinically important difference (MCID) for the Oswestry Disability Index (ODI) score at 12months post-operatively. A total of 2281 patients were included in the study cohort. The average age was 59.4years (SD 14.8). The median CWT was 43.1weeks (IQR 17.8 - 60.6) and only 30.9% had treatment within 6months. Patients were more likely achieve the MCID for the ODI at 12months post-operatively if they had surgery within 6 months of referral from primary care (OR 1.22; 95% CI 1.11 - 1.34). This relationship was also found at a benchmark CWT time of 3months (OR 1.33; 95% CI 1.15 - 1.54) though not at 12months (OR 1.08; 95% CI 0.97 - 1.20). Patients who received operative treatment within a 3- and 6-month benchmark between referral and surgery were more likely to experience noticeable improvement in post-operative function.

Evidence from an Applied Health Research Question: Health Equity Profiles of Community Health Centre (CHC) and non-CHC clients

Objective/ApproachThe Black Health Equity Working Group's Applied Health Research Question aimed to compare cancer screening rates and surgical wait times between community health centre (CHC) clients based on race-related data and non-CHC clients. CHC client data was categorized by self-identified racial groups, with Black self-identification compared to non-Black racialized, White, and missing racial self-identification, and non-CHC clients. Health card numbers were encrypted to link individuals to the Primary Care Population dataset for breast, cervical, and colorectal cancer screening rates. Surgical wait time indicators, such as the number of patients undergoing surgery and average wait times for initial consultation and completed surgeries, were derived from the Wait Time Information System. Assessments were conducted semi-annually from fiscal year 2018 to 2021. ResultsFollowing the onset of COVID-19, CHC clients self-identifying as Black experienced the most significant decrease (6.8%) in colorectal screenings compared to other groups. Mammogram screenings remained consistently higher for CHC clients self-identifying as Black pre- and post-pandemic. Average cervical cancer screening rates were approximately 8% higher among CHC clients compared to non-CHC clients, irrespective of racial self-identification. However, due to small sample sizes and missing data among self-identified racial groups, trends in surgical wait times for both CHC and non-CHC clients were unstable. Conclusion/ImplicationsTailored interventions targeting Black CHC clients can enhance cancer screening rates, particularly colorectal screenings. The analysis of CHC data offers valuable insights into race-based disparities in health outcomes. Improved data completeness is essential for accurately assessing health outcome variations among different racial groups.

Consequences of delaying non-urgent surgeries during COVID-19: a population-based retrospective cohort study in Alberta, Canada

ObjectivesTo ensure sufficient resources to care for patients with COVID-19, healthcare systems delayed non-urgent surgeries to free capacity. This study explores the consequences of delaying non-urgent surgery on surgical care...

Measurement of and Reporting on Wait Times for Priority Procedures in Canada.

Despite ongoing efforts to deliver more timely care to Canadians, patients across Canada continued to wait longer for joint replacements, cancer surgery and diagnostic imaging in 2023 compared with 2019 (the pre-pandemic period). In 2023, the wait time for cataract surgery returned to the pre-pandemic level. For radiation therapy and hip fracture repair, the proportion of patients treated within the benchmark decreased slightly compared to the pre-pandemic period.

Factors Influencing Time to Definitive Care in Hip Fracture Patients in a Rural Health System.

Current literature has not adequately addressed factors affecting wait times for hip fracture surgery in the rural setting. This study aims to assess the factors affecting admission, transit, and preoperative wait times that impact the timeliness of hip fracture surgery within a rural health system. A single-center retrospective cross-sectional study was conducted in a rural community comprising five community hospitals and two receiving hospitals. A trauma registry study included all hip fracture cases from 2019. Mean, standard deviation, median, and interquartile range were calculated for admission wait times, transit times to the receiving hospitals, and preoperative wait times in hours. Metrics based on means or medians were developed for these wait times. A total of 163 patients met the inclusion criteria. The emergency department wait times before and after admission to the community hospitals were 1 hour and 2.5hours, respectively. The transit times from the community hospitals, ranging from shorter to farther distances, to receiving hospitals were 40minutes and 1 hour, respectively. The preoperative wait time for admitted and transferred patients was 12hours. Our study outlines a methodology for establishing wait time metrics that impact surgical timeliness for hip fracture patients within a rural healthcare system. We recommend conducting comparable studies with larger sample sizes across different healthcare systems.

The Effect of Insurance Type on Time to Anterior Cruciate Ligament Reconstruction in Pediatric Patients: A Critically Appraised Topic

Clinical Scenario: Delay in surgery for anterior cruciate ligament (ACL) injuries increases the risk of complications including secondary injuries. Previous research has shown individuals with public insurance have greater delays in care for a variety of health conditions. Clinical Question: In pediatric patients with ACL injuries, is the time from injury to surgery longer for patients with public insurance than patients with private insurance? Summary of Key Findings: Four studies met the inclusion criteria. All studies reported a greater wait time for surgery in pediatric patients with public insurance. Clinical Bottom Line: There is moderate evidence indicating that there is a delay in ACL surgery for pediatric patients with public insurance compared to those with private insurance. Strength of Recommendation: Grade B evidence exists that there is a delay in surgery for ACL injuries in pediatric patients with public insurance compared to those with private insurance.

P.147 The growing problem of spine surgery wait times in British Columbia: longitudinal trends and impacts on perioperative outcomes

Background: Surgical delays are in common in Canada. Wait times in elective spine surgery and their impact on outcomes remain uncharacterized. Methods: This was a single-center analysis of elective spine surgery data between 2009-2020. Wait times between referral and consultation (T1), consultation and surgical booking (Ti), and booking and surgery (T2) were assessed. Results: 2041 patients were included. Longitudinal analyses were adjusted for age, sex, diagnosis, surgical volume, while outcomes analyses were age and sex-adjusted. Total T1+Ti+T2 increased 8.1% annually (p<0.001). T1 decreased 4.3% annually (p=0.032). It was not associated with adverse events (AEs) or disposition. Every 100 days of T1 was associated with 1.0% longer hospitalization (p=0.001). Ti increased 21.0% annually (p<0.001). Every 100 days of Ti was associated with 2.9% increased odds of an adverse event (p=0.002), 1.8% longer hospitalization (p<0.001), and 15.9% increased likelihood of discharge home (p<0.001). T2 increased 7.0% annually (p<0.001) and was not associated with AEs. Every 100 days of T2 was associated with 11.6% longer hospitalization (p<0.001) and 76.5% increased likelihood of discharge home (p<0.001). Conclusions: Total wait times for elective spine surgery have increased between 2009-2020. Notably, Ti increased ninefold and was associated with AEs. This study highlights areas of delay and targets for healthcare optimization.

#1664 Assessing vascular access thrombectomy service adherence to GIRFT recommendations: single centre experience

Abstract Background and Aims Studies showed that early thrombectomy of dialysis vascular access (VA) is associated with better outcomes [1], especially for native VA [2]. Timely treatment of VA thrombosis within 24-48 hours is recommended by GIRFT to minimize access loss and requirement for dialysis line insertion [3]. Our centre has approximately 430 HD patients but has no on-site vascular surgery or vascular access interventional radiology (IR) service. Wait time for elective VA surgery or fistuloplasty is >8 weeks and VA surveillance is based on routine clinical monitoring. VA prevalence is 62% AV fistula (AVF), 2% AV graft (AVG), 36% central venous catheter (CVC). Fistula thrombectomy is provided at another centre, with increasing waiting times over recent years due to shortage of interventional radiologists. This study evaluates adherence to GIRFT recommendations for patients at our centre requiring thrombectomy and will identify potential local strategies to reduce fistula thrombosis and CVC use. Method In a 24-months’ retrospective cohort analysis of maintenance HD patients with permanent VA, we obtained data on: Results 44 patients with permanent VA developed VA thrombosis. The median waiting time for thrombectomy was 8 days (Fig. 1). Post-intervention primary patency rate was 71% at 3-months and 60% at 6-months (Fig. 2). 61% of patients required hospital admission with a 12-day median length of stay, with total inpatient admission days of 403 days over 2 years (2022-2023), and total cost of £246,065 (Figs. 3 and 4). The median CFD-extended was 356 days, i.e. 9 days/patient/year with VA-related complications (Fig. 5). Conclusion This study shows that our centre's VA thrombectomy service falls far outside the GIRFT recommendation of intervention within 24-48 hours. The high associated rates of CVC use, inpatient bed days and avoidable costs place a heavy burden on patient outcomes and NHS resources. The ideal solution of an on-site thrombectomy service is difficult to achieve due to lack of vascular IR support. In response to this study, we now aim to reduce thrombosis rates by training additional interventional nephrologists in elective fistuloplasty, implementing a robust VA surveillance to improve early detection of malfunctioning VA suitable for elective intervention and improving staff education on fistula care.

Abstract PO3-23-02: Delays in breast cancer surgery during the COVID-19 pandemic: A population-based analysis

Abstract BACKGROUND: At various times during the COVID-19 pandemic, access to operating room resources were restricted in Ontario, Canada. This resulted in triaging of all non-urgent cases, including breast cancer (BC) surgery. Recent single institution studies have identified treatment delays during the immediate pandemic time period. The objective of this study was to assess the impact of the pandemic on wait times for breast cancer surgery at a population level. METHODS: We identified patients with a BC diagnosis between January 1, 2018 and November 30, 2021 in Ontario, Canada. Three cohorts were defined based on the following time periods: pre-pandemic (baseline) (January 2018 to 14 March 2020), immediate pandemic (March 15, 2020 to June 13, 2020), and peri-pandemic (June 14, 2020 to November 30, 2021). Time to event analysis was conducted for time to a patient’s first BC surgery. A subgroup analysis was conducted for patients who underwent neoadjuvant chemotherapy (NAC). RESULTS: The study cohort consisted of 36,639 patients with a new diagnosis of BC. Of them 30,862 patients underwent surgery (84.2%) within 18 months after diagnosis. The probability of BC patients undergoing surgery each month from their date of diagnosis was significantly lower (i.e. longer wait times) for patients diagnosed in the immediate and peri-pandemic period compared to patients diagnosed in the pre-pandemic period (log-rank P < 0.001). At eight weeks from date of diagnosis, the probability of having had surgery was 65.1% (95% CI: 64.5-65.8%) for patients diagnosed in the pre-pandemic period, 56.1% (95% CI: 53.6-58.6%) for immediate pandemic and 59.0% (95% CI: 58.2-59.8%) for peri-pandemic. Time for 80% of patients to have BC surgery was 5.4 months in the pre-pandemic, 5.9 months in the immediate pandemic, and 6.0 months in the peri-pandemic period. Among patients who received NAC (N=6,121; 16.7% of cohort), the probability of undergoing surgery in each month from the date of diagnosis was similar for patients diagnosed in the pre and peri-pandemic periods, but was higher (i.e. shorter wait time) for the cohort of patients diagnosed during the immediate pandemic time period (log-rank P < 0.001). At six months from date of diagnosis, the probability of surgery for patients who received NAC was 50.7% (95% CI: 48.9-52.5%), 61.6% (95% CI: 56.6-66.6%), and 50.9% (95% CI: 49.0-52.8%) for patients diagnosed in the pre-, immediate, and peri-pandemic periods respectively. Time for 80% NAC patients to have a surgery was 7.2 months in the immediate pandemic period, shorter than the 8.2 months in the pre-pandemic and 8.0 months in the peri-pandemic periods. CONCLUSIONS: In this large population-based study of BC patients in Ontario, we identified a delay in time to surgery in the immediate pandemic period that persisted into the peri-pandemic period. However, among patients receiving NAC there was a shorter wait time during the immediate pandemic and wait times for this group have returned to pre-pandemic levels. This is likely due to surgical prioritization of this group, despite pandemic related resource restrictions. Further research is needed to explore the regional variability and how use of neoadjuvant endocrine therapy interacted with surgical treatment timelines. Citation Format: Gary Ko, Amanda Roberts, Qing Li, Ning Liu, Toni Zhong, Eitan Amir, Anne Koch, Andrea Covelli, Vivianne Freitas, Emma Reel, Antoine Eskander, Tulin Cil. Delays in breast cancer surgery during the COVID-19 pandemic: A population-based analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-23-02.

Abstract PO1-09-09: The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey

Abstract Background: Breast cancer is the most common neoplasm in Brazilian women, with high percent of patients diagnosed in advanced stages. Metastatic breast cancer (mBC) is a challenge in the country, where 75% of the population is covered by public health system (Sistema Único de Saúde, SUS). We conducted an on-line survey to describe the journey of human epidermal growth factor receptor 2-negative (HER2-), hormone receptor positive (RH+) mBC patients across public scenario in Brazil. Methods: An on-line survey comprised of 39 to 48 (depending on the kind of some questions, which could open another question in case of affirmative answer) objective questions were sent by e-mail to180 oncologists working in public and private health care system. Questions were focused on assessing wait time for first treatment after admission in the hospital in both systems, availability of oncological drugs within SUS according to essential medicines list by World Health Organization, and presence of palliative and multidisciplinary teams in both systems. Continuous variables were measured by median and mean. The level of statistical significance adopted was 5% with Teste p two-sided. Analyses were performed using SAS statistical software (version 25.0). Results: We had 150 respondents working in SUS and private health system, which fulfilled the inclusion criteria to participate in this survey. The other 30 respondents were excluded from the study because they worked exclusively in SUS or exclusively in the private system, and their answers were not analyzed. Median wait time for surgery was 60 days in the SUS (N=150) and 30 days in the private health system (N=150) e (p < 0,0001). Regardless of chemotherapy provided, median waiting time was 30 and 15 days in the SUS (N=150) and the private health system (N=150), respectively (p < 0,0001). Most oncologists in the SUS (N=125, 83.3%) pointed to endocrine therapy as their first-choice treatment in mBC. Concerning endocrine therapy in the SUS, Gonadotropin-Releasing Hormone Agonist (GnRHa) was available, and it was prescribed by 54 (36.0%) and Fulvestrant for 72 (48.0%) of respondents. Considering chemotherapy, weekly paclitaxel alone or combined with platin were available and they were prescribed by 124 (82.6%) and 109 (72.6%) of oncologists respectively. Vinorelbine was available and it was prescribed according to oncologists’ report by 109 (72.6%) and Pegylated liposomal doxorubicin (PLD) by 38 (25.3%) of oncologists. Oncologists answered agree or strongly agree that they had a multidisciplinary care team in SUS 77,3% (N =116) versus 87,3% (N=131) in the private system (p=0.022). Concerning palliative care 66,09% (N= 99) in the SUS versus 82,0% (N=123) in the private system answered that they agreed or strongly agreed that this service was available (p=0.001). Conclusions: The Brazilian government has continuously improved delivery of services and medicines via the public system (SUS), but there are still significant differences within this system and versus the private sector. Unavailability of endocrine therapy agents as GnRHa and Fulvestrant, and some chemotherapy agents as PLD and Vinorelbine for high percentage of patients, raises the existence of disparities within SUS. Also, longer waiting times for treatment in the SUS, lower availability of support teams such multidisciplinary and palliative care, they point out disparities between SUS and private health systems. The lack of a National Cancer Control Program and low health investment by Brazilian government might explain the difference in cancer patients’ access. Citation Format: Heloísa Resende, Igor Soares, Angélica Renó, Ana Cunha, Vinícius Aguiar, Letícia Tureta, Viviane Pereira. The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-09.

Hospital Queues, Patient Health, and Labor Supply

Long waits for health care raise concerns about the consequences of delayed treatment. We use variation in queue congestion to estimate effects of wait time for orthopedic surgery. We do not find that longer wait times lead to increased health care utilization. However, we do find persistent reductions in labor supply: long waits increase medium to long-term work absences and permanent disability receipt. Effects are driven by individuals who are on sick leave at referral. Our results are consistent with patterns of state dependence, where extended periods of temporary disability while awaiting treatment create persistent barriers to returning to work. (JEL I11, I12, I18, J22)

The Impact of Surgical Wait Time and Hospital Stay on the Incidence of Burn Wound Infection and Related Complications at a Single Tertiary Hospital Centre: A 10-Year Experience

Introduction: Admitted patients with burn injuries require prompt treatment and shorter hospital stays to avoid hospital-acquired infections and associated complications. This study aimed to determine the impact of time to the first surgery, and total length of hospital stay on the incidence of BWI and associated complications in adult patients with moderate burn injuries at a single tertiary hospital burn center. Methods: A retrospective chart review identified burn patients admitted to the Burn Unit between January 2011 and January 2021. The incidences of BWI and complications were documented. Univariate logistic regressions were performed, with significance set at P < .05. Results: A total of 171 patients were included in the study. The mean age was 50.8 years (range, 94-18 years), with 64 (37.4%) females. The mean wait time for surgery and total hospital stay was 2.6 days (SD = 2.5; 1-15 days) and 18.6 days (SD = 16.0; 1-125 days), respectively. Precisely, 47 patients (27.5%) were associated with positive burn wound cultures, with 23 patients (13.5%) experiencing clinical burn wound complications. Wait time to surgery did not significantly impact the incidence of BWI (OR = 0.97, P = .72) or related complications (OR = 0.97, P = .61). Total hospital stay was significantly associated with the incidence of BWI (OR = 1.05, P < .001) and related complications (OR = 1.02, P = .03). Conclusions: Delay to surgery may not be a significant risk factor of BWI and related complications in patients with burn injuries. Half of positive burn wound cultures are associated with objective clinical infection and subsequent complications. However, total hospital stay may be clinically important.

Using photodynamic approaches to improve the diagnostic accuracy of image guided surgery

SignificanceIncomplete surgical resection of tumors using white light and preoperative imaging causes tumor reoccurrence. Antibody-dye conjugate can target and accumulate into the tumor but has longer wait times for surgery following administration. This process can be expedited using PDP which not only increase the delivery but also improves the diagnostic accuracy in tumor detection. ApproachThe mice bearing FaDu head and neck tumors were administered with Cetuximab-IRDye800 (Cet-IRDye800) and treated with sub-therapeutic dose of PDT (photodynamic Priming; PDP). The accumulation and distribution of Cet-IRDye800 into the tumor were measured and analyzed. ResultsPDP improves and expedites the delivery of Cet-IRDye800 into the tumors significantly. It also improves diagnostic accuracy in tumor detection with respect to the vicinal salivary gland. ConclusionsThis study highlights, for the first time, that PDP enhances the rate and extend of delivery of the fluorescently labeled antibodies for the effective photodynamic image guided surgery.

(347) A Single Center Review of Access to Gender Affirming Surgical Care: Analysis of Consultation to Surgery Conversion Rates and Patient Wait Times

Abstract Introduction The demand for gender-affirming surgical care has grown exponentially throughout the United States throughout the last decade. Even within gender care programs, patients face complex barriers to receiving multidisciplinary, gender-affirming care. The differences in access to care among different gender-affirming procedures remain understudied. Understanding the barriers that patients face within our multidisciplinary gender care program is imperative to addressing the needs of our population. Objective To assess the differences in wait times and successful completion of surgery following initial consultation across multiple gender-affirming surgical procedures. Methods Records of all patients seeking an initial consultation for gender-affirming surgical care at a single center from February 2018 to March 2022 were reviewed. Recorded demographic data of patients included age, sex assigned at birth, gender identity, insurance type, race, and ethnicity. We categorized gender-affirming surgical care into the following procedures: vaginoplasty, phalloplasty, mastectomy, breast augmentation, facial feminization, orchiectomy, hysterectomy, and other. The conversion rate was defined as the percentage of patients who completed surgery after an initial consult. Patients were followed until April 2023, a minimum of >365 days. Contact to consult was defined as the time between a patient’s initial contact for scheduling an appointment and a formal in-office consult, and consult to surgery was determined by the time from the first consult to the actual surgery. Comparisons were analyzed in SPSS with Pearson chi-square test or one-way ANOVA with post-hoc comparisons as appropriate. Results Our comprehensive gender care program conducted 621 consultations and 438 surgeries between February 2018 and March 2022. The difference between conversion rates among surgeries was statistically significant by Pearson chi-square test (p <0.001), with vaginoplasty and phalloplasty having the lowest conversion rate at 31%, with post-hoc adjusted residuals < -2. Facial feminization and mastectomy had a higher conversion rate (88% and 79%, respectively). Regarding time between major events, the time from patient contact to in-office consult was not statistically significant with one-way ANOVA between gender-affirming procedures at p= 0.53. However, the time from consult to surgery was statistically significant between groups at p= 0.002. Phalloplasty had a statistically longer consult to surgery time at 416 days (p<0.02) than any other surgery on post-hoc testing. Vaginoplasty had a statistically lengthier wait at 289 days (p<0.05) than mastectomy and breast augmentation. Conclusions Phalloplasty and vaginoplasty have the lowest conversion rates of all gender-affirming procedures. Among patients who undergo a phalloplasty, the consult to surgery wait time is statistically longer than any other surgery. For vaginoplasty patients, the consult to surgery wait is statistically longer than for mastectomy and breast augmentation. The differences in conversion rates and wait times from consult to surgery raise questions about disparities and access to care, particularly for more complex gender-affirming surgical procedures, that will be further explored in the dataset. Disclosure No.

Timing of Surgery and Outcomes in Chronic Rhinosinusitis: A Narrative Review and Meta-Analysis.

Surgery is often indicated in the treatment of medically recalcitrant chronic rhinosinusitis (CRS). There is conflicting evidence on the impact of timeliness of sinus surgery on the degree of perceived symptom improvement in CRS. The goal of this study was to systematically evaluate the available literature on the relationship between patient wait times for endoscopic sinus surgery (ESS) and postoperative changes in patient-reported outcome measures. Ovid, MEDLINE, CINAHL, and Cochrane Library of Systematic Reviews between January 2000 and September 1, 2023, were searched. A total of 931 studies were independently screened by 2 reviewers. Two studies were included in the meta-analysis, while 4 others were included in a narrative review. Two studies consisting of 1606 patients were included in the meta-analysis. A mean difference in 22-Item Sino-Nasal Outcome Test (SNOT-22) of -0.3 (95% CI = -3.9 to 3.3, I2 = 89%, P < .01 was observed between "long" and "short" groups, while a mean difference in SNOT-22 of -0.1 (95% CI = -2.5 to 2.3, I2 = 80%, P = .03) was observed between "long" and "mid" groups. Patients who receive surgery earlier on their disease process (ie, earlier from the time of diagnosis to eventual surgery) appear to require less access to healthcare resources including prescription medications, thus suggesting better disease control. There is conflicting evidence to conclude whether timing of ESS affects disease-specific measures in patients with CRS. Patients who receive surgery earlier appear to have lower demands on healthcare utilization including visits and prescription use. Our study suggests there is a need for increased access to surgical specialists who manage patients with CRS, and better understanding by primary care specialists in how to manage CRS when specialist access is not available.

Surgeon- and hospital-level variation in wait times for scheduled non-urgent surgery in Ontario, Canada: A cross-sectional population-based study.

Canadian health systems fare poorly in providing timely access to elective surgical care, which is crucial for quality, trust, and satisfaction. We conducted a cross-sectional analysis of surgical wait times for adults receiving non-urgent cataract surgery, knee arthroplasty, hip arthroplasty, gallbladder surgery, and non-cancer uterine surgery in Ontario, Canada, between 2013 and 2019. We obtained data from the Wait Times Information System (WTIS) database. Inter- and intra-hospital and surgeon variations in wait time were described graphically with caterpillar plots. We used non-nested 3-level hierarchical random effects models to estimate variation partition coefficients, quantifying the proportion of wait time variance attributable to surgeons and hospitals. A total of 942,605 procedures at 107 healthcare facilities, conducted by 1,834 surgeons, were included in the analysis. We observed significant intra- and inter-provider variations in wait times across all five surgical procedures. Inter-facility median wait time varied between six-fold for gallbladder surgery and 15-fold for knee arthroplasty. Inter-surgeon variation was more pronounced, ranging from a 17-fold median wait time difference for cataract surgery to a 216-fold difference for non-cancer uterine surgery. The proportion of variation in wait times attributable to facilities ranged from 6.2% for gallbladder surgery to 23.0% for cataract surgery. In comparison, surgeon-related variation ranged from 16.0% for non-cancer uterine surgery to 28.0% for cataract surgery. There is extreme variability in surgical wait times for five common, high-volume, non-urgent surgical procedures. Strategies to address surgical wait times must address the variation between service providers through better coordination of supply and demand. Approaches such as single-entry models could improve surgical system performance.

Impact of the COVID-19 pandemic on diagnosis of renal cell carcinoma and disease stage at presentation.

Renal cell carcinoma (RCC) is often associated with significant morbidity and mortality, with overall survival contingent on multiple factors - most importantly, disease stage at diagnosis. Disruptions in healthcare delivery during the COVID-19 pandemic have resulted in various reported diagnostic and treatment delays, which have had detrimental impacts on malignancies such as RCC. Surgically managed cases of RCC at our center were identified using a retrospective chart review of all nephrectomies conducted from March 1, 2018, to February 28, 2023. Examination of disease characteristics in three time period cohorts (before, during, and following the COVID-19 pandemic) was undertaken. Timeframes were consistent with implementation and abolition of public health restrictions in the province of Newfoundland and Labrador. A total of 483 surgically managed RCC cases were identified during the study period. The median age was 65 years (interquartile range [IQR] 56-71), and 62.3% of patients were male. Demographics did not vary across timeframes. Before and during the pandemic, pathologic stage 3 (pT3) disease was reported in 38.9% and 35.4% of cases, respectively, whereas the post-pandemic period saw this presentation in 50.0% of patients. Surgical wait times increased significantly across study timeframes (p=0.003). The first year following the COVID-19 pandemic saw an 11.1% increase in patients presenting with pT3 RCC. These findings are suggestive of a clinically significant stage migration, which paired with prolonged wait times for surgery, provide critical consideration in the urgency of diagnostic and treatment decisions for RCC in the immediate future.

Abstract A132: Time to treatment by neighborhood among endometrial intraepithelial neoplasia and endometrial cancer patients

Abstract Objective: To examine interval wait time for surgery in EIN and Endometrial Cancer patients at a single institution and identify potential disparities in access to care Methods: At this single institution, five priority neighborhoods where medically underserved populations reside have been designated from a Community Health Needs Assessment. We performed a retrospective chart review of patients with EIN or endometrial cancer at a single institution between 2016-2019. Patients from one of five priority neighborhoods were compared with patients from other zip codes within the same state. Results: 100 patients from priority neighborhoods and 104 patients from other neighborhoods within the same state were identified. Mean age was similar (59.74 vs 58.15 yrs, p 0.372) and rates of private insurance status were similar (66% vs 52%, p 0.08). Priority neighborhood patients were more likely to identify as Black or Hispanic (30.0% vs 4.81%; 18.0% vs 0%, p &amp;lt;0.001), and were more likely to speak a non-English primary language (19.0% vs 2.88%, p 0.005). Priority neighborhood patients had a higher Charlson Deyo co-morbidity score (2.44 vs 2.49, p 0.809). Patients had a similar rates of advanced stage disease (Stage III or IV 16 vs 16, p 0.213) and histologic subtype (Endometrioid 47.5% vs 59.6%; Serous or Clear Cell 13.46% vs 14.75%, p 0.962). The mean interval to treatment by primary surgery from referral visit was 68.9 days for non-priority neighborhood patients compared to 80.12 days for priority neighborhood patients (p 0.478). In univariate analysis, race/ethnicity, primary language, and insurance status were not significant factors impacting time to treatment. Conclusion: Interval wait time to primary surgery among a single institution cohort was longer for priority neighborhood patients. This study highlights potential barriers to healthcare access that are unaddressed by current systems. Citation Format: Victoria Wang, Hadley Reid, Andrea Pelletier, Trinity Russell, Lucy Chen, Reagan Marsh, Colleen Feltmate, Alexi Wright, Kevin Elias. Time to treatment by neighborhood among endometrial intraepithelial neoplasia and endometrial cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A132.