Improving the provision of carotid endarterectomy in line with UK Government targets requires more than just motivated surgeons.

introductionCarotid endarterectomy confers maximum benefit in symptomatic patients provided it is performed within < 2 weeks of presentation, but few centres achieve this target. The objective of this study was to determine if a surgeon with an interest in carotid endarterectomy could make simple modifications to practice so that carotid endarterectomy was performed within 2 weeks of referral in the majority of patients. PATIENTS AND

methodsAudit of 44 symptomatic patients undergoing carotid endarterectomy by one surgeon in 2007 after implementing simple changes in practice (e.g. ad hoc cancellation of non-urgent cases, ad hoc utilisation of cancelled theatre sessions). Outcomes were compared with 36 symptomatic patients undergoing carotid endarterectomy in 2006.

resultsThere was only a modest reduction in delay to surgery. In 2006, 11% underwent carotid endarterectomy within 2 weeks of referral increasing to 20% in 2007. By 2007, 48% underwent surgery within 4 weeks compared with 33% in 2006.

conclusionsNotwithstanding the additional impact of delays from symptom onset to referral, achieving a 2-week target will require more than motivated surgeons making simple changes to practice. It seems inevitable that vascular units will have to identify 1-2 'ring fenced' theatre sessions per week (but some could go unused) and surgeons will have to accept that they may not always operate on the patients they work-up.