Surgical Wait Time Research Articles

Preoperative wait times in high-grade endometrial cancer: do surgical delays impact patient survival?

<h3>Objectives:</h3> Practice guidelines advocating for the regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were released by Cancer Care Ontario in June 2013. We sought to determine the impact this policy had on contemporary surgical wait times. Moreover, a discussion about the impact of delays in treatment has never been more timely than in the context of the current COVID19 pandemic, which has burdened health care systems around the world. Our primary objective was to establish whether longer wait time to surgery is a predictor of survival in patients with high grade endometrial cancer. <h3>Methods:</h3> This was a retrospective cohort study, which included patients diagnosed with non-endometrioid high-grade endometrial cancer (serous, carcinosarcoma, clear cell, and undifferentiated) between 2003 and 2017. A total of 2 regionalization periods were defined, before and after January 2014 to allow 6 months for knowledge translation after guideline publication. Patients were identified in population-based administrative provincial data sources. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between wait time and overall survival, as measured from time of surgery. <h3>Results:</h3> We identified 3518 patients with high grade endometrial cancer. Median wait time between diagnosis and surgery for the entire cohort did not significantly change with regionalization of care (50 vs 52 days, p=0.14). Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 55 days compared to 59 days pre-regionalization (p=0.0002), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p=0.0006). Survival was worst for patients who had surgery within 14 days of diagnosis (HR death 2.7, 95% CI 1.61-4.51 for 1-7 days and HR death 1.96, 95% CI 1.5-2.57 for 8-14 days), indicating disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic-oncology appointment (HR death 1.19, 95% CI 1.04-1.36 for 46-60 days and HR death 1.42, 95% CI 1.11-1.82). <h3>Conclusions:</h3> Regionalization of surgery for high grade endometrial cancer has not had a negative impact on surgical wait times. Impact on survival is seen with patients who have surgery more than 45 days after surgical consultation.

Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty.

AimsIn countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip.MethodsThe study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and hip arthroplasties (TKA, THA) between 2011 and 2017. Patients waiting longer than the recommended 180 days Canadian national standard were compared to patients waiting equal or less than the standard WT. The primary outcome measure was acute LoS postoperatively. Secondarily, patient demographics, comorbidities, and perioperative parameters were correlated with LoS with multivariate regression.ResultsA total of 11,833 TKAs and 6,627 THAs were included in the study. Mean WT for TKA was 348 days (1 to 3,605) with mean LoS of 3.6 days (1 to 98). Mean WT for THA was 267 days (1 to 2,015) with mean LoS of 4.0 days (1 to 143). There was a significant increase in mean LoS for TKA waiting longer than 180 days (2.5% (SE 1.1); p = 0.028). There was no significant association for THA. Age, sex, surgical year, admittance from home, rural residence, household income, hospital facility, the need for blood transfusion, and comorbidities were all found to influence LoS.ConclusionSurgical WT longer than 180 days resulted in increased acute LoS for primary TKA. Meeting a shorter WT target may be cost-saving in a social healthcare system by having shorter LoS.Cite this article: Bone Jt Open 2021;2(8):679–684.

Testicular Torsion Patients Should Be Manually Detorsed at Diagnosis: A Propensity Score Matched Analysis of the Influence of Interhospital Transfer and Surgical Wait Times on Surgical Organ Salvage.

The aim of the study was to assess organ salvage in testicular torsion patients submitted to manual detorsion according to interhospital transfer and surgical wait times. Retrospective analysis of consecutive surgically treated testicular torsion patients between 2012 and 2018. We compared testicular surgical salvage in testicular torsion patients submitted to manual detorsion either at clinical diagnosis (immediate detorsion) or after interhospital transfer from lower level-of-care facilities (delayed detorsion) and estimated the influence of interhospital transfer and surgical wait times on outcomes. Analysis included Bayesian logistic regression after propensity score matching. We excluded patients first examined at off-state and private facilities, with prediagnostic time of more than 24 hours, not initially diagnosed with testicular torsion or not submitted to manual detorsion at any time. One hundred sixty-two patients (median age, 15.8 years) fulfilled inclusion criteria. The median prediagnostic, transfer, and surgical wait times were respectively 4.9, 2.4, and 4.3 hours, with 58 patients undergoing immediate and 104 delayed detorsion. Propensity score matching for prediagnostic and surgical wait times paired 58 immediate with 40 delayed detorsion patients, with corresponding surgical salvage rates of 54/58 (93%) and 33/40 (82%). Forty-seven patients (29%) still had torsion at surgery. Transfer time was inversely associated with testicular salvage, with median 13% greater probability of an unfavorable outcome for each hour of transfer time. Similarly, each hour of surgical wait time decreased surgical salvage by 6%. Immediate detorsion led to improved surgical outcomes in testicular torsion patients. Because of residual torsion, surgery for detorsed patients should not be postponed.

Impact of Surgical Wait Time on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma With Hydronephrosis.

Background and ObjectivesDue to the inevitability of waiting time for surgery, this problem seems to have become more pronounced since the outbreak of COVID-19, and due to the high incidence of preoperative hydronephrosis in upper urinary tract urothelial carcinoma (UTUC) patients, it is particularly important to explore the impact of preoperative waiting time and hydronephrosis on upper urinary urothelial carcinoma.Methods316 patients with UTUC who underwent radical surgery at a high-volume center in China between January 2008 and December 2019 were included in this study. We retrospectively collected the clinicopathologic data from the medical records, including age, sex, smoking history, ECOG performance status (ECOG PS), body mass index (BMI), tumor location and size, number of lesions, T stage, N stage, surgical approach and occurrence of hydronephrosis, lymph node invasion, lymph node dissection, surgical margin, tumor necrosis, infiltrative tumor architecture, lymphovascular invasion and concomitant bladder cancer. Surgical wait time was defined as the interval between initial imaging diagnosis and radical surgery of UTUC. Hydronephrosis was defined as abnormal dilation of the renal pelvis and calyces due to obstruction of the urinary system. Firstly, all patients were divided into short-wait (<31 days), intermediate-wait (31-90 days) and long-wait (>90 days) groups according to the surgical wait time. The clinicopathological characteristics of each group were evaluated and the survival was compared. For patients with hydronephrosis, we subsequently divided them into two groups: short-wait (≤60 days) and long-wait (>60 days) groups according to the surgical wait time. Univariate and multivariate COX regression analysis were performed to evaluate the prognostic risk factor for patients with hydronephrosis.ResultsA total of 316 patients with UTUC were included in this study with a median surgical wait time of 22 days (IQR 11-71 days). Of the 316 patients, 173 were classified into the short-wait group (54.7%), 69 into the intermediate-wait group (21.8%) and 74 into the long-wait group (23.5%). The median follow-up time for all patients was 43 months (IQR 28-67months). The median surgical wait times of the short-wait, intermediate-wait and long-wait group were12 days (IQR 8-17days), 42days (IQR 37-65days) and 191days (IQR 129-372days), respectively. The 5-year overall survival (OS) of all patients was 54.3%. The 5-year OS of short-wait, intermediate-wait and long-wait groups were 56.4%, 59.3% and 35.1%, respectively (P=0.045). The 5-year cancer-specific survival (CSS) of short-wait, intermediate-wait and long-wait groups were 65.8%, 70.9% and 39.6%, respectively (P=0.032). In the subgroup analysis, we divided 158 UTUC patients with hydronephrosis into short-wait group (≤60 days) and long-wait group (> 60 days), 120 patients were included in the short-wait group and 38 patients in the long-wait group. The median surgical wait times of the short-wait and long-wait group were 14days (IQR 8-28days) and 174days (IQR 100-369days), respectively. The 5-year OS of long-wait group was significantly lower than the OS of short-wait group (44.2% vs. 55.1%, P =0.023). The 5-year CSS of long-wait and short-wait group were 49.1% and 61.7%, respectively (P=0.041). In multivariate Cox regression analysis of UTUC patients with hydronephrosis, surgical wait time, tumor grade, pathological T stage, and tumor size were independent risk factors for OS and CSS. Lymph node involvement was also a prognostic factor for CSS.ConclusionFor patients with UTUC, the surgical wait time should be limited to less than 3 months. For UTUC patients with hydronephrosis, the OS and CSS of patients with surgical wait time of more than 60 days were relatively shorted than those of patients with surgical wait time of less than 60 days.

Nephrectomy Delay of More than 10 Weeks from Diagnosis Is Associated with Decreased Overall Survival in pT3 RCC.

In this study, we aimed to evaluate the impact of surgical wait time (SWT) on outcomes of patients with renal cell carcinoma (RCC), and to investigate risk factors associated with prolonged SWT. Using the National Cancer Database, we retrospectively reviewed the records of patients with pT3 RCC treated with radical or partial nephrectomy between 2004 and 2014. The cohort was divided based on SWT. The primary outcome was 5-year overall survival (OS). Logistic regression analysis was used to investigate the risk factors associated with delayed surgery. Cox proportional hazards models were fitted to assess relations between SWT and 5-year OS after adjusting for confounding factors. A total of 22,653 patients were included in the analysis. Patients with SWT > 10 weeks had higher occurrence of upstaging. Using logistic regression, we found that female patients, African-American or Spanish origin patients, treatment in academic or integrated network cancer center, lack of insurance, median household income of <$38,000, and the Charlson–Deyo score of ≥1 were more likely to have prolonged SWT. SWT > 10 weeks was associated with decreased 5-year OS (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15–1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, gender, race, insurance status, Charlson–Deyo score, tumor size, and surgical margin status (adjusted HR, 1.13; 95% CI, 1.04–1.24). In conclusion, the vast majority of patients underwent surgery within 10 weeks. There is a statistically significant trend of increasing SWT over the study period. SWT > 10 weeks is associated with decreased 5-year OS.

Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative.

Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.

Safety of Prolonged Wait Time for Nephrectomy for Clinically Localized Renal Cell Carcinoma.

BackgroundThere is usually a surgical wait time before nephrectomy for patients with clinically localized renal cell carcinoma, and many factors can influence this preoperative wait time. A relatively prolonged wait time may cause tumor progression. Therefore, we assessed the effect of preoperative wait time on the prognosis of patients with clinically localized renal cell carcinoma.MethodsThe outcomes of 561 patients with clinically localized renal cell carcinoma who underwent nephrectomy between July 2011 and March 2017 were retrospectively evaluated. According to the wait time before surgery, we divided the patients into three groups: short-wait group (≤ 30 days), intermediate-wait group (> 30 and ≤ 90 days), and long-wait group (>90 days). The clinicopathological characteristics were evaluated, and the survival rates of the three groups were compared.ResultsThis study included 370 male (66%) and 191(34%) female patients, with a median age of 64 years. There were 520 patients with stage T1 and 41 patients with stage T2 tumors. The median interval between diagnosis and surgery was 21 days. There were no significant differences in age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, body mass index, tumor size, surgical approach, surgical procedure, pathological subtype, tumor stage, tumor grade, and residual tumor among the three groups. Overall survival(OS) and cancer-specific survival (CSS) were comparable; the 5-year OS of the short-, intermediate-, and long-wait time groups were 84.2%, 82.0%, and 89.8%, respectively (P=0.732). The 5-year CSS rates of the short-, intermediate-, and long-wait time groups were 87.1%, 88.9%, and 90.4%, respectively (P=0.896). Multivariate analysis revealed that wait time was not an independent prognostic factor for OS or CSS.ConclusionProlonged surgical wait time (> 90 days) does not influence survival in patients with clinically localized renal cell carcinoma.

The burden of waiting: wait times for pediatric surgical procedures in Quebec and compliance with national benchmarks.

BackgroundWait time information and compliance with national guidelines are limited to a few adult conditions in the province of Quebec. We aimed to assess compliance with Paediatric Canadian Access Targets for Surgery (P-CATS) guidelines and determine the burden incurred due to waiting for 3 common elective surgical conditions (inguinal hernia, cryptorchidism and hypospadias) in a pediatric population.MethodsWe carried out a population-based retrospective cohort study of randomly selected children residing in Quebec without complex chronic medical conditions, using administrative databases belonging to the Régie de l’assurance maladie du Québec for the period 2010–2013. Disability-adjusted life years (DALYs) were calculated to measure the burden due to waiting. Multivariate forward regression identified risk factors for compliance with national guidelines.ResultsSurgical wait time information was assessed for 1515 patients, and specialist referral wait time was assessed for 1389 patients. Compliance with P-CATS benchmarks was 76.6% for seeing a specialist and 60.7% for receiving surgery. Regression analysis identified older age (p < 0.0001) and referring physician specialty (p = 0.001) as risk factors affecting specialist referral wait time target compliance, whereas older age (p = 0.040), referring physician specialty (p = 0.043) and surgeon specialty (p = 0.002) were significant determinants in surgical wait time compliance. The total burden accrued due to waiting beyond benchmarks was 35 DALYs.ConclusionOur results show that provincial compliance rates with wait time benchmarks are still inadequate and need improvement. Patient age and physician specialty were both found to have significant effects on wait time target compliance.

Mortality Increases When Radical Nephrectomy is Delayed More Than 60 Days for T3 Renal Cell Carcinoma.

Background: Radical nephrectomy is widely accepted as the default management option for patients with T3 renal cell carcinoma (RCC). However, it may require a certain time before surgery for various reasons. There are concerns that the delay in surgery may affect postoperative outcomes. The present study aimed to evaluate the impact of surgical wait time on survival in patients with T3 RCC. Methods: We retrospectively selected 138 patients with T3 RCC who underwent radical surgery between July 2009 and December 2019. Surgical wait time was defined as the period from initial imaging diagnosis to surgery. Patients were divided into the following 2 groups according to wait time: short-wait group(≤60 days), and long-wait group (>60 days). The clinical and pathological characteristics were evaluated. The overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) of each group were calculated and compared. Age, gender, interval, tumor size, pathological grade, Eastern Cooperative Oncology Group performance status (ECOG PS), surgical approach, year of surgery, and pathological type were included in the multivariable model. Results: This study included 91 male (65.9%) and 47 female (34.1%) patients. The median age of all patients was 60 years (interquartile range [IQR] 52-68 years). The median body mass index is 22.2 kg/m2 (IQR 18.9-24.7 kg/m2). There were 128 patients (92.8%) with pT3a disease and 10 patients (7.3%) with pT3b disease. The median surgical wait time for all patients was 16 days (IQR 10-77 days). The median surgical wait time of the short- and long-wait groups was 12 days (IQR 8-16 days) and 92 days (IQR 79-115 days), respectively. Until the last follow-up, 54 patients died. Among them, 49 patients (90.7%) died of tumor-related causes, and 5 patients (9.3%) died of other causes. There are 1 and 4 cases in the short-wait and long-wait groups, respectively. There were no significant differences in gender, ECOG PS, American society of anesthesiologists score, Charlson comorbidity index, clinical T stage, clinical N stage, and body mass index. And there were no significant differences in tumor size, surgical approach, year of surgery, pathological type, tumor grade, pathological T stage, pathological N stage, and venous involvement between the 2 groups. OS, CSS, and RFS were compared. The 5-year OS of the short- and long-wait time groups were 65.0% and 40.9%, respectively (P = .030). The 5-year CSS rates of the short- and long-wait time groups were 68.7% and 51.5%, respectively (P = .012). The 5-year RFS rates of the short- and long-wait time groups were 61.5% and 46.8%, respectively (P = .119). Multivariable analysis revealed that surgical wait time interval and tumor size were independent risk factors for OS and that wait time was also an independent risk factor for CCS. Conclusion: Delay in radical surgery beyond 60 days can negatively affect OS in patients with T3 RCC.

Abstract 15673: Racial Disparities in Referral for Pre-operative Cardiovascular Evaluation, Surgical Wait Time, and Weight Loss in Patients Undergoing Bariatric Surgery

Introduction: White patients undergo bariatric surgery more frequently and with fewer complications compared to non-white patients. Yet, racial disparities in referral pattern for preoperative cardiovascular evaluation (CVE) are unexplored. We hypothesized that racial disparities exist in preoperative CVE in white vs. non-white patients undergoing bariatric surgery. Methods: We identified consecutive patients undergoing bariatric surgery at our institution from 2014-2018. The association of white vs. non-white race with referral for CVE, cardiac testing, surgical wait time, and postoperative weight loss was determined in a multivariate model adjusting for baseline demographic comorbidities and income. Additional adjustment for insurance provider was made for surgical wait time. Results: Of the 797 patients undergoing bariatric surgery during the study period, 86% (n=682) were non-white. White vs. non-white patients had similar age, gender distribution, and prevalence of hypertension, hyperlipidemia, Type 2 diabetes, and heart failure. A similar proportion of whites vs. non-whites were referred to cardiology for pre-operative evaluation (65% vs. 68%, p=0.52), while whites were more likely to undergo further preoperative cardiac testing after adjustment (68% vs. 55%, p=0.04; adjusted, OR 0.6, 95%CI 0.35-1.0, p=0.05). Despite less cardiac testing, non-white patients referred to cardiology waited longer for surgery (9.9 months vs. 12.1 months, p=0.008), including after adjustment (HR 0.7, 95%CI 0.53-0.91, p= 0.008. Weight loss at 6 months was higher in whites (12.9 kg/m 2 vs. 11.95 kg/m 2 , p=0.03), but equivalent at 1 year (whites 14.9 kg/m 2 vs. non-whites 14.3 kg/m 2 , p=0.33). Conclusions: In a bariatric surgery population, white vs. non-white patients were referred for CVE in similar proportion. However, white patients underwent more subsequent cardiac testing pre-operatively when compared to non-whites yet had a shorter wait time for surgery. Early weight loss was greater in whites, but equivalent between groups at 1 year.

Feasibility of Prehabilitation Prior to Breast Cancer Surgery: A Mixed-Methods Study.

BackgroundBreast cancer surgery results in numerous acute and long-term adverse outcomes; the degree to which these can be mitigated or prevented through prehabilitation is unknown.MethodsWe conducted a longitudinal, single-arm, mixed-methods study to examine the feasibility of prehabilitation in 22 women undergoing breast cancer surgery. All participants received an individualized exercise prescription including upper quadrant-specific resistance and mobility training and aerobic exercise for the duration of their surgical wait time. Feasibility was assessed by recruitment, adherence, attrition, and intervention-related adverse event rates. An exploratory investigation of intervention efficacy was conducted via a 6-min walk test, upper-quadrant strength and range of motion, volumetric chances associated with lymphedema, and participant-reported quality of life, fatigue, pain, and disability. Outcome assessments were conducted at baseline, prior to surgery, and at six and 12 weeks after surgery. Semi-structured interviews with a subset of participants (n = 5) and health-care providers (H; n = 2) were conducted to provide further insights about intervention feasibility. Qualitative data were analyzed using a hybrid inductive and deductive thematic analysis approach.ResultsRecruitment and attrition rates were 62 and 36%, respectively. Average prehabilitation duration was 31 days (range = 7–69 days). Seventy six percent of participants complied with at least 70% of their prehabilitation prescription. There was a clinically significant increase in the 6-min walk distance from baseline to the preoperative assessment (57 m, 95% CI = −7.52, 121.7). The interviews revealed that the intervention was favorably received by participants and HCPs and included suggestions that prehabilitation (i) should be offered to all surgical candidates, (ii) is an avenue to regain control in the preoperative period, (iii) is a facilitator of postoperative recovery, and (iv) is an opportunity to provide education regarding postoperative rehabilitation protocols. A preference for multimodal prehabilitation (including dietetic and psychological counseling) was also highlighted.ConclusionOur findings suggest that surgical prehabilitation in women with breast cancer is feasible. Data are hampered by study sample size and lack of a control group. Thus, randomized controlled trials to examine prehabilitation efficacy in people with breast cancer, especially interventions employing a multimodal strategy, are warranted.

Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery

Delaying cataract surgery is associated with an increased risk of falls, but whether routine preoperative testing delays cataract surgery long enough to cause clinical harm is unknown. We sought to determine whether the use of routine preoperative testing leads to harm in the form of delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery. Retrospective, observational cohort study using 2006-2014 Medicare claims. Medicare beneficiaries 66+ years of age with a Current Procedural Terminology claim for ocular biometry. We measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥ 30 days or ≥ 90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥ 75% of their patients) compared with patients of low-testing physicians. We also estimated the number of days of delay attributable to high-testing physicians. Incidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay associated with physician testing behavior. Of 248 345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited ≥ 30 days and ≥ 90 days to undergo surgery (31.4% and 8.2% vs. 25.0% and 5.5%, respectively; P < 0.0001 for both). Falls before surgery in patients of high-testing physicians increased by 43% within the 90 days after ocular biometry (1.0% vs. 0.7%; P < 0.0001). The adjusted odds ratio of falling within 90 days of biometry in patients of high-testing physicians versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03-1.19; P= 0.008). After adjusting for surgical wait time, the odds ratio decreased to 1.07 (95% CI, 1.00-1.15; P= 0.06). The delay associated with having a high-testing physician was approximately 8 days (estimate, 7.97 days; 95% CI, 6.40-9.55 days; P < 0.0001). Other factors associated with delayed surgery included patient race (non-White), Northeast region, ophthalmologist ≤ 40 years of age, and low surgical volume. Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.

Impact of Surgical Wait Time to Hysterectomy for Benign Gynecologic Disease

Study ObjectiveTo determine the impact of surgical wait time on healthcare use and surgical outcomes for patients undergoing hysterectomy for benign gynecologic indications.DesignRetrospective cohort study.SettingUrban, academic tertiary care center.PatientsPatients who underwent hysterectomy for benign disease between 2012 and 2018.InterventionsNone.Measurements and Main ResultsPatients were categorized into 2 groups, dichotomized by surgical wait times >30 days or ≤30 days. Healthcare use was measured by the number of discrete patient interactions with the healthcare system through phone calls, secure electronic messaging, and office and emergency room visits. Univariate and multivariable logistic regression models were performed to assess the association between surgical wait time and healthcare use and perioperative outcomes while controlling for confounders. A total of 277 patients were included in our analysis: 106 (38.3%) had surgical wait times >30 days (median 47 days, range 24–68 days), and 171 (67.1%) had surgical wait times ≤30 days (median 19 days; range 12–26 days). The groups did not differ by age, insurance status, substance use, or comorbid conditions. Patients in the group with surgical wait times >30 days were more likely to have increased healthcare use (69 of 106, 65% vs 43 of 171, 25%; odds ratio 5.55; 95% confidence interval, 3.27–9.41). There were no differences in intraoperative complications (9 of 106, 8% vs 19 of 171, 11%; p = .482) or postoperative complications (28 of 106, 26% vs 32 of 171, 19%; p = .13) between the groups; however, after controlling for potential confounders, patients with surgical wait times >30 days were 3.22 times more likely to be readmitted than patients with surgical wait times ≤30 days (95% confidence interval, 1.27–8.19).ConclusionA surgical wait time >30 days in patients undergoing a hysterectomy for benign disease is associated with increased healthcare use in the interim. Although patients who experience longer surgical wait times do not experience worse surgical outcomes, they may be at higher risk for readmission after surgery. Targeted interventions to optimize perioperative coordination of care for patients undergoing a hysterectomy for benign disease, especially those within vulnerable populations, are needed to improve quality of care, decrease any redundant or inefficient healthcare use, and reduce any unnecessary delays.

Impact of Time to Surgery and Surgical Delay on Oncologic Outcomes for Renal Cell Carcinoma.

The time between radiographic identification of a renal tumor and surgery can be concerning for patients and clinicians due to fears of tumor progression while awaiting treatment. This study aimed to evaluate the association between surgical wait time and oncologic outcomes for patients with renal cell carcinoma. The Canadian Kidney Cancer Information System is a multi-institutional prospective cohort initiated in January 2011. Patients with clinical stage T1b or greater renal cell carcinoma diagnosed between January 2011 and December 2019 were included in this analysis. Outcomes of interest were pathological up staging, cancer recurrence, cancer specific survival and overall survival. Time to recurrence and death were estimated using Kaplan-Meier estimates and associations were determined using Cox proportional hazards models. A total of 1,769 patients satisfied the study criteria. Median wait times were 54 days (IQR 29-86) for the overall cohort and 81 days (IQR 49-127) for cT1b tumors (1,166 patients), 45 days (IQR 27-71) for cT2 tumors (672 cases) and 35 days (IQR 18-61) for cT3/4 tumors (563). Adjusting for comorbidity, tumor size, grade, histological subtype, margin status and pathological stage, there was no association between prolonged wait time and cancer recurrence or death. In the context of current surgeon triaging practices surgical wait times up to 24 weeks were not associated with adverse oncologic outcomes after 2 years of followup.

The impact of wait times on oncological outcome in high-risk patients with endometrial cancer.

To evaluate the impact of surgical wait times on outcome of patients with grade 3 endometrial cancer. All consecutive patients surgically treated for grade 3 endometrial cancer between 2007 and 2015 were included. Patients were divided into two groups based on the time interval between endometrial biopsy and surgery: wait time from biopsy to surgery ≤12 weeks (84 days) vs more than 12 weeks. Survival analyses were conducted using log-rank tests and Cox proportional hazards models. A total of 136 patients with grade 3 endometrial cancer were followed for a median of 5.6 years. Fifty-one women (37.5%) waited more than 12 weeks for surgery. Prolonged surgical wait times were not associated with advanced stage at surgery, positive lymph nodes, increased lymphovascular space invasion, and tumor size (P = .8, P = 1.0, P = .2, P = .9, respectively). In multivariable analysis adjusted for clinical and pathological factors, wait times did not significantly affect disease-specific survival (adjusted hazard ratio [HR]: 1.2, 95% confidence interval [CI], 0.6-2.5, P = .6), overall survival (HR: 1.1, 95% CI, 0.6-2.1, P = .7), or progression-free survival (HR: 0.9, 95% CI, 0.5-1.7, P = .8). Prolonged surgical wait time for poorly differentiated endometrial cancer seemed to have a limited impact on clinical outcomes compared to biological factors.

The Successful Implementation of a Trauma and Acute Care Surgery Model in Ecuador.

For years, surgical emergencies in Ecuador were managed on a case-by-case basis without significant standardization. To address these issues, the Regional Hospital Vicente Corral Moscoso adapted and implemented a model of "trauma and acute care surgery" (TACS) to the reality of Cuenca, Ecuador. A cohort study was carried out, comparing patients exposed to the traditional model and patients exposed to the TACS model. Variables assessed included number of surgical patients attended to in the emergency department, number of surgical interventions, number of surgeries performed per surgeon, surgical wait time, length of stay and in-hospital mortality. The total number of surgical interventions increased (3919.6-5745.8, p ≤ 0.05); by extension, the total number of surgeries performed per surgeon also increased (5.37-223.68, p ≤ 0.05). We observed a statistically significant decrease in surgical wait time (10.6-3.2h for emergency general surgery, 6.3-1.6h for trauma, p ≤ 0.05). Length of stay decreased in trauma patients (9-6days, p ≤ 0.05). Higher mortality was found in the traditional model (p ≤ 0.05) compared to the TACS model. The implementation of TACS model in a resource-restrained hospital in Latin America had a positive impact by decreasing surgical waiting time in trauma and emergency surgery patients and length of stay in trauma patients. We also noted a statistically significant decrease in mortality. Savings to the overall system and patients can be inferred by decreased mortality, length of stay and surgical wait times. To our knowledge, this is the first implementation of a TACS model described in Latin America.

Prehabilitation for Prostate cancer surgery.

Prostatectomy is associated with short- and long-term morbidity, which includes attenuation of cardiovascular and muscle function, as well as the deterioration of lean body mass. Physical function is a known predictor of morbidity and mortality, with initial evidence indicating that pre-surgical exercise is associated with fewer post-surgical complications and shorter hospitalisation. Prehabilitation has been previously shown to be more effective in enhancing postoperative functional capacity than rehabilitation alone. Evidence grows indicating benefits to clinical, physical and quality of life outcomes. Exercising within this critical period between cancer diagnosis and surgery allows the usage of surgical wait time to promote and facilitate health behaviour changes that can lead to altering prostate cancer patient management. By combining exercise with a nutritional and psychological intervention a prostate cancer patient can be set up to significantly improve preoperative physical and mental fitness in preparation for surgery and beyond.

Impact of surgical wait times on oncologic outcomes in resectable pancreas adenocarcinoma

BackgroundTimely surgical resection in patients with suspected or diagnosed pancreas adenocarcinoma is an essential part of care. We hypothesized that longer surgical wait time was associated with worse oncologic outcomes. MethodsA retrospective cohort of patients (N = 144) with resectable pancreas adenocarcinoma was divided into four wait time groups (<4, 4–8, 8–12, and >12 weeks), defined from the time of diagnosis on cross-sectional imaging. Overall and recurrence-free survival were analyzed using the Kaplan–Meier method and Cox proportional hazards regression. A higher rate of conversion to palliative bypass in patients waiting over 4 weeks was observed and further analyzed using post-hoc multivariate regression. ResultsOn multivariable analysis, longer wait time was associated with improved overall (HR 0.49, 95% CI: 0.28–0.85) and recurrence-free survival (HR 0.29, 95% CI: 0.15–0.56) in >12 weeks compared to <4 weeks group. On post-hoc analysis, longer wait time over 8 weeks was positively associated with palliative bypass (OR 5.33, 95% CI: 1.32–27.88). ConclusionWait time over 8 weeks was associated with a higher rate of palliative bypass. There was an improvement in overall and recurrence-free survival in patients who waited over 12 weeks, likely due to selection bias.

Safety of prolonged wait time for gastrectomy in clinical stage I gastric cancer

BackgroundPatients with stage I gastric cancer tend to wait for surgery. Although the cancer may progress during such a delay, effects of wait time for surgery on survival remain inconsistent. Here, we evaluated the safety of surgical wait time on survival of patients with clinical stage I gastric cancer. MethodsThe outcomes of 556 patients who underwent gastrectomy for clinical stage I gastric cancer between January 2007 and December 2011 were retrospectively evaluated. Patients were stratified into three groups based on wait time: short- (<61 days, n = 185), intermediate- (61–90 days, n = 218), and long-wait (91–180 days, n = 153) groups. Clinicopathological findings and survival were compared among the groups. ResultsThe median wait time was 72 days. Age and comorbidities differed among the groups, but clinical and pathological cancer stages did not. Overall survival was comparable; the 5-year overall survival was 90.2%, 93.6%, and 88.8% in the short-, intermediate-, and long-wait groups, respectively. Multivariate analysis revealed that wait time was not an independent prognostic factor for overall survival. Adjusted hazard ratios (HRs) were 0.69 (p = 0.262) and 1.03 (p = 0.926) in the intermediate- and long-wait groups, respectively, with short wait time as the reference. Relapse-free survival was comparable among the groups (intermediate-wait HR = 0.80, p = 0.476; long-wait HR = 1.10, p = 0.740). ConclusionA half-year wait time for surgery was not independently associated with survival of patients with clinical stage I gastric cancer and may therefore be acceptable.

Factors associated with time to surgery in melanoma: An analysis of the National Cancer Database

Timely treatment for melanoma may affect survival, and characterizing the predictors of delay may inform intervention strategies. To determine characteristics associated with the interval between diagnosis and surgery in melanoma. The National Cancer Database was used to examine factors associated with the interval between diagnosis and surgery among 213 146 patients with stage I, II, or III cutaneous melanoma. Among privately insured patients, time to surgery was longer for patients aged 50 to 70years (hazard ratio [HR], 0.96) and older than 70years (HR, 0.83) compared with those younger than 50years. In contrast, patients without private insurance experienced a shorter surgical wait time if older (HR for age 50-70years, 1.07; HR for age >70years, 1.05). Other factors associated with longer surgical interval included nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma location. Use of zip code-level data for income and education level. Patients with melanoma experience disparities in timely receipt of surgery.