Assessment of patient waiting times for vascular surgery.

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.

Diabetic dense premacular hemorrhage. A possible indication for prompt vitrectomy.

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.

Pars plana vitrectomy for the complications of diabetic retinopathy: a report on 131 cases.

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.