Access to surgery and medical consequences of delays

Abstract

Wait lists are a common tool for managing access to elective surgery. However, little evidence is available on the health impact of delaying surgery for various conditions. Other than preoperative mortality, adverse events experienced by patients while on a wait list have not been systematically examined. Without these data, appropriate access time for surgery must be determined on the basis of expert opinion. When treatment is delayed, the condition of a patient on a surgical wait list may deteriorate and require urgent medical attention. In this case, emergency admission for the awaited procedure may be regarded as an adverse effect of waiting. In this chapter, we present the results of recent wait list studies that quantified the risk of delayed treatment in patients accepted for coronary artery bypass surgery and in patients awaiting elective cholecystectomy. Our results have implications for developing waiting-time limits for elective surgical procedure.