UK Stroke Prevention Surgeries Unacceptably Delaied
Only one in five UK patients have surgery to reduce their risk of stroke within the two week target time set by the National Institute for Health and Clinical Excellence (NICE), finds a study published on bmj.com today. The authors call for major improvements in services to enable early surgery to prevent strokes in high risk patients.
Every year in the UK, about 120,000 people have a transient ischaemic attack (TIA) or minor stroke and up to 30% die within a month. Stroke is also the single largest cause of severe disability in adults and costs the economy £7bn a year.
Studies show that a surgical procedure known as carotid endarterectomy reduces the risk of stroke in patients with stenosis (a narrowed or blocked carotid artery) and symptoms of having had a minor stroke, but it is unclear how many patients have had symptoms and how long they have to wait for surgery.
So a team of researchers, led by Professor Alison Halliday at St George's University of London, assessed the timeliness of carotid endarterectomy services in the UK. They surveyed 240 surgeons from 102 hospital trusts across the UK about all carotid endarterectomies they performed between December 2005 and December 2007.
Of 5,513 patients who underwent surgery, 83% had a history of transient ischaemic attack or stroke, but only 20% had their operation within two weeks of onset of symptoms and 30% waited more than 12 weeks. The average delay from referral to surgery was 40 days. Twenty-nine patients (0.5%) died while in hospital, while 48 patients (1%) died 30 days after surgery, mainly from strokes.
These findings show unacceptable delays between symptom and operation in the UK, say the authors. Such delays are associated with a high risk of disabling or fatal stroke before surgery, and the benefit of surgery consequently falls rapidly with increasing delay.
Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes, they conclude.