RESUMO
OBJECTIVES: To assess patient waiting times for vascular surgery and to determine if complications of the disease develop while the patients are awaiting surgery. DESIGN: Prospective cohort study. SETTING: A university-affiliated tertiary care institution. PATIENTS: All 554 patients who underwent scheduled vascular surgical procedures between April 1995 and October 1996. OUTCOME MEASURES: A literature review carried out to develop guidelines for acceptable waiting times for surgery associated with various vascular disorders based on their natural history (benchmark target); actual waiting times, defined as the interval from the date each patient was booked for surgery to the date of admission to hospital for the procedure; the proportion of patients admitted within the benchmark targets; and whether prolonged waiting time placed patients at risk for complications of their disease. RESULTS: Of the 554 patients, 382 (69%) were admitted within the benchmark waiting times. Of 84 patients having an abdominal aortic aneurysm, the aneurysm ruptured during the waiting period in 6, and 4 of them died, for a complication rate of 7% and a death rate of 5%. Two of the 6 aneurysms ruptured after the patient had waited longer than the target time. Three of 100 patients with symptomatic carotid artery stenosis awaiting admission for carotid endarterectomy suffered ischemic stroke, for a 3% complication rate; all had waited longer than the target period. One patient suffered occlusion of a femoropopliteal bypass graft while awaiting revision of a stenosed bypass graft. CONCLUSIONS: This study suggests that although most patients are admitted for operation within the benchmark time, one-third are admitted late and may suffer serious complications of their disease while awaiting admission for the procedure.
Assuntos
Admissão do Paciente/estatística & dados numéricos , Doenças Vasculares/complicações , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Listas de Espera , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Derivação Arteriovenosa Cirúrgica , Benchmarking , Colúmbia Britânica/epidemiologia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Progressão da Doença , Pesquisa sobre Serviços de Saúde , Hospitais Universitários , Humanos , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/cirurgia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
A review was undertaken of nine eyes of nine patients who suffered tightly bound dense premacular hemorrhage as a complication of proliferative diabetic retinopathy. Patients who did not receive vitrectomy within four weeks of the onset of the hemorrhage all progressed to late macular traction and visual acuity no better than 6/30. Of the five patients who received vitrectomy within four weeks of the onset of the hemorrhage, none developed significant late macular traction and all achieved visual acuity of 6/12 or better. It is possible that the tightly bound dense premacular hemorrhage represents an indication for vitrectomy within one month of its onset.
Assuntos
Retinopatia Diabética/complicações , Oftalmopatias/cirurgia , Hemorragia Retiniana/cirurgia , Vitrectomia , Adolescente , Adulto , Retinopatia Diabética/etiologia , Oftalmopatias/etiologia , Oftalmopatias/patologia , Oftalmopatias/fisiopatologia , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/etiologia , Disco Óptico/irrigação sanguínea , Hemorragia Retiniana/patologia , Hemorragia Retiniana/fisiopatologia , Acuidade VisualRESUMO
The results of primary vitrectomy for the complications of proliferative diabetic retinopathy were explored in 131 eyes of 105 patients. A minimum of 6 months' follow-up was obtained. The primary indications for surgery were persistent vitreous hemorrhage (in 66% of the eyes) and progressive tractional macular detachment (in 31%). Technical (surgical) success (clearing of the ocular media or relief of macular traction, or both) was achieved by the time of the last examination in 69% of the eyes; it was achieved in 70% of those with persistent vitreous hemorrhage and in 68% of those with tractional macular detachment. Visual improvement was observed in 55% of all the eyes.