In a recent study published in the journal CMAJ Open, a team of researchers examined the impact of patient and operational factors on wait times in a multidisciplinary bariatric surgery program, and found that some patients with obesity could be identified during the referral process as being at risk for longer wait time.
In the retrospective study entitled “Patient and operational factors affecting wait times in a bariatric surgery program in Toronto: a retrospective cohort study,” Fayez A. Quereshy from the Department of Psychiatry, University Health Network, University of Toronto in Canada and colleagues analyzed 1664 patients who were referred to a tertiary care centre (University Health Network, Toronto Western Hospital, Toronto) for bariatric surgery from 2008 to 2011. In the multidisciplinary, multistage program, the preoperative evaluation includes medical, social work, dietary, psychological or psychiatric assessments, and a surgical consultation before patients are deemed eligible for surgery.
The results revealed that of the total patients included in the study, 724 underwent surgery with a mean wait time of 440 days and a median wait time of 445 days. Wait times ranged from 3 months to 4 years. Results showed that patients with active substance use and those who entered the program in more recent operational periods had longer wait times.
Additionally, the median time-to-surgery increased over 3 discrete operational periods, characterized by specific program changes related to scheduling and staffing levels, and varying referral rates and defined surgical targets.
Based on the results, the researchers explained that some types of patients should be identified early in the screening process, and program administrators should develop personalized care plans that address the patients’ specific needs. The researchers further stated that the current exclusion criteria for surgery might be too lenient, especially when considering substance abuse, and that previous operational interventions have not decreased wait times.
“We are currently investigating how to schedule patients for assessments to improve health care provider utilization, and what the optimal proportion of new to follow-up appointment slots should be. Furthermore, better triaging enables early treatment and relevant diagnostic tests (e.g., blood work, sleep study) to be completed even while patients undergo further assessments. This would decrease the waiting time when patients are closer to surgery and could also reduce late-stage patient attrition,” the researchers concluded in the article.