Carotid endarterectomy audit findings

Patients presenting with symptoms of stroke or transient ischaemic attack (TIA) are at increased risk of stroke and those with symptoms, such as visual loss, weakness in the face/arm/leg, who also have significant narrowing of the carotid artery are at high risk of having a more severe stroke, hence more urgent surgery is important to prevent this happening. Carotid surgery is of the greatest benefit if performed quickly following the onset of symptoms and the National Institute for Clinical Excellence (NICE) and the National Stroke Strategy have set standards of 14 days and 48 hours respectively from symptom to surgery. Round 4 of the UK Carotid Endarterectomy Audit analysed 5,543 cases and found that participation has increased to involve 98% of Trusts in England, Scotland, Northern Ireland and Wales, making this the largest and most robust audit of carotid endarterectomy practice in the UK. The audit found that the average delay from onset of symptoms to undergoing surgery continues to decline, demonstrating continued improvement in the quality of service. The latest audit found that the median delay between onset of symptoms and undergoing surgery was 15 days, compared to 21 days in Round 3. There has also been an overall increase – from 40% to 49% – in the proportion of patients treated within 14 days from symptom to surgery as specified in NICE guidance. There is evidence that too many patients lack awareness about the need to seek urgent medical advice as soon as possible. Despite identifying a decline in delays between symptom onset and surgery, the audit found that there was still considerable variation in performance among hospitals. There are multiple reasons for this, including patient awareness and organisational structure/pathway management. Patients receive surgery more quickly in London than in all other regions. The audit demonstrated that better performing services offer seven-day clinic access and multidisciplinary team working.