Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 193

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 
     

  Table of Contents  
REVIEW ARTICLE
Year : 2014  |  Volume : 55  |  Issue : 6  |  Page : 443-451  

The surgical waiting time initiative: A review of the Nigerian situation


Department of Trauma and Orthopaedic Surgery, Leeds University Teaching Hospitals, Leeds, West Yorkshire, United Kingdom

Date of Web Publication14-Nov-2014

Correspondence Address:
Imran Haruna Abdulkareem
Department of Trauma and Orthopaedic Surgery, B Floor Clarendon Wing, Leeds General Infi rmary, Great George Street, Leeds-LS1 3EX, West Yorkshire
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0300-1652.144692

Rights and Permissions
   Abstract 

The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24.5%) publications were from obstetrics and gynaecology (O & G) alone, but these were mostly related to emergency antenatal care rather than surgery. Therefore, more research and initiative needs to be undertaken from all the surgical sub-specialties in order to disseminate this concept of SWAT towards early diagnosis and treatment of elective life-threatening conditions, as well as effective patient care. Adopting this concept will help healthcare managers and policy makers to stream line and ring face resources to cater for non-urgent or semi-urgent cases presenting to our hospitals in Nigeria.

Keywords: Cancellations, day surgery, elective surgery, ring-fencing, SWAT, waiting list, waiting time


How to cite this article:
Abdulkareem IH. The surgical waiting time initiative: A review of the Nigerian situation. Niger Med J 2014;55:443-51

How to cite this URL:
Abdulkareem IH. The surgical waiting time initiative: A review of the Nigerian situation. Niger Med J [serial online] 2014 [cited 2019 Nov 12];55:443-51. Available from: http://www.nigeriamedj.com/text.asp?2014/55/6/443/144692


   Introduction Top


Waiting times mean different things to different medical practitioners in Nigeria. However, this is a review of the surgical waiting times, as currently understood and practised in Nigeria by different health professionals. The surgical waiting time initiative (SWAT) was introduced in the UK and other developed countries, in order to reduce waiting lists and increase efficiency of patient care (Frankel, 1989). [1] It was later supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. SWAT is now well established in Western countries like UK (Mills et al., 1991), [2] USA and Canada (Casas et al., 2007) [3] where it is practised alongside day surgery; but not in developing countries like Nigeria where this concept is still new and evolving. So far, most of the centres in Nigeria do not have a ring-fenced or dedicated elective surgery service and most of these cases are admitted to the same wards with emergency patients, with no dedicated theatre time or space. This leads to frequent cancellations of the elective cases as they are perceived to be less urgent than emergencies, and so the patients end up suffering while their diseases may continue to progress or deteriorate, especially cancers.

In 2000, the UK department of Health (DoH) set up a mandatory target for urgent referral and management of patients with suspected bowel cancer. They recommended that all patients referred from their general practitioners must be reviewed by a specialist within 2 weeks and must be offered treatment within 62 days (Mukherjee et al., 2010). [4] This initiative has since been extended and rolled out to include other cancers and public health issues of interest in the UK (Lewis et al., 2005). [5] In June 2004, the UK National Health Service (NHS) introduced the 18 week patient pathway, which guaranteed that no patient should wait for more than eighteen weeks before any planned (elective) surgery in the UK (Bruni et al., 2010). [6] This has resulted in a significant improvement in the early diagnosis and treatment of patients referred from their general practitioners (GPs), especially in the fields of oncology, orthopaedics, general surgery, rheumatology and cardiology, among others. [1],[2],[3],[4],[5],[6]


   Materials and Methods Top


A search was carried out in PubMed, Google, AJOL, Athens and Ovid for relevant publications on surgical waiting times in Nigeria. The search included all articles published within and outside Nigeria related to the topic in question, and also restricted to articles published in English language only. The types of articles considered include both prospective and retrospective case series, case reports, review articles, literature reviews, reports, guidelines, published reviews and commentaries. Search words used include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria.


   Results Top


A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. [7-43] A total of 11 publications (29.7%) were related to emergency surgery waiting times, [7-17] 10 (27%) were related to clinic waiting times, [32-41] 9 (24.3%) were related to day case surgery, [23-31] 2 (5.5%) were related to investigation waiting times [42]],[[43] and only 5 (13.5%) articles were specifically published on elective surgery waiting times. [18],[19],[20],[21],[22] A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ENT, 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. These results are illustrated in [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7].
Table 1: Summary of intervention types in relation to waiting time

Click here to view
Table 2: Summary of specialties in relation to waiting times

Click here to view
Table 3: Summary of articles focusing on emergency surgery/care

Click here to view
Table 4: Summary of articles focusing on elective surgery waiting times

Click here to view
Table 5: Summary of articles focusing on day surgery

Click here to view
Table 6: Summary of articles focusing on clinic waiting times

Click here to view
Table 7: Summary of articles focusing on investigation waiting time

Click here to view



   Discussion Top


A review of the published articles on waiting times in Nigeria showed that 11/37 (29.7%) of the publications focused on emergency surgery/care [Table 1] and [Table 3]. [7-17] This is not surprising, because there is currently a lot of focus on emergency care and surgery in many health centres in Nigeria. This may be a result of delayed presentation by patients, inadequate funding of the hospitals, lack of dedicated elective surgery services, lack of awareness among patients with non-urgent medical conditions and the general negative attitudes of the healthcare practitioners and managers towards non-urgent (elective) surgery. A total of 10/37 (27%) of the publications were focused on clinic waiting times [Table 1] and [Table 6], [18],[19],[20],[21],[22] which is a reflection of the growing public health interest on measures of patient satisfaction with healthcare services. This is a good development as these outcomes can be used to improve the overall standard of healthcare facilities in Nigeria.

Furthermore, 9/37 (24.3%) of the publications were related to day surgery practice in Nigeria; [23-31] and most of the authors highlighted the increasing role of day surgery in facilitating and even ring-fencing elective surgeries in order to prevent or reduce frequent cancellations in favour of emergency cases [Tables 1 and 5], [23-31] and 2/37 (5.5%) of the published articles were related to investigation waiting times [Tables 1 and 7]. However, none of these articles specifically focused on elective or planned surgical waiting times as well as the need for an organised initiative to improve the waiting times for non-urgent surgical intervention in Nigeria.

In contrast, only 5/37 (13.5%) of the relevant published articles were specifically related to elective surgery waiting times [Tables 1 and 4]; and most of these articles are non-randomised retrospective case series in single centres; only one study was a prospective review of laparoscopic procedures in paediatric patients (Misauno et al., 2012). Also, one of the five publications related to elective surgery reviewed the effects of cancellations on the surgical waiting list, and the authors recommended adequate planning and good communication between staff and patients as the key to avoiding frequent cancellations of surgical lists (Kolawole et al., 2002). One of the articles was a review of day surgery practice in Nigeria, and explained the ideal concepts of this idea, as well as its role in carrying out elective surgeries in order to reduce the surgical waiting times (Abdulkareem, 2011).

With regards to specific sub-specialties, 9/37 (24.5%) of the publications were from OG, but a few of these publications related to emergency antenatal care rather than emergency surgery; 7/37 (19%) were related to waiting times in general surgery, which is the most established surgical sub-specialty in Nigeria, 5/37 (13.5%) of the publications were related to public health, which reflects the increasing effort of physicians in getting patient feedback regarding their satisfaction with healthcare services in Nigeria, whereas orthopaedics, paediatric surgery and family medicine each had 3/37 (8%) of the publications related to various types of waiting times, ophthalmology had 2/37 (5.5%) of the published articles, while anaesthesia, plastic surgery, ENT, dental surgery and urology each had 1/37 (2.7%) of the relevant publications. These results are illustrated in Table 2.

A review of the current literature elsewhere showed that management of elective surgical waiting times has become well established in the healthcare systems of many developed countries such as UK, USA, Australia and Canada. This is especially true in the fields of cancer, joint replacement surgeries (arthroplasties), sight restoration, cardiac problems and diagnostic imaging among others (Bruni et al., 2007). [44] Briggs et al., (2011) [45] reviewed the effect of active management of surgical waiting lists in a urological service in Australia, which resulted in a significant reduction in the surgical waiting times for semi-urgent and non-urgent patients from 248-180 days in the 10-month period of the review. Other workers (Mills et al., 2005) [46] also revealed a significant reduction in the surgical waiting times of their patients as a result of the waiting time initiative in an ENT surgical unit.

Gray et al., (2010) [47] also investigated the effects of reducing the pre-operative waiting times in patients undergoing spinal surgery, and revealed that this reduction in waiting times did not compromise the patient's quality of care, but rather had a positive influence on the patients due to the added convenience. In another study of patients suspected to have colorectal cancer, Mukherjee et al., [4] observed that the 2-week referral pathway reduces both diagnostic and treatment waiting times for these patients, and led to an improved rate of early diagnosis of colorectal cancer in their cohort of patients.

In a systematic review of the effect of prolonged surgical waiting times for patients with renal cancers, Jewett et al., (2006) [48] revealed that waiting times ranged from 26 to 82 days, with a median of 64 days from referral to surgery in one Canadian study. This was found to have exceeded the National and International guidelines, which recommended 2-4 weeks for all cancer surgeries. However, they observed that there were no studies looking at the association between surgical delays and clinical outcomes in cancer patients. In another Canadian study, however, Fradet et al., (2006) [49] did a systematic review of 18 published articles evaluating waiting times for bladder cancer surgery, 10 of which evaluated the effects of prolonged waiting times and overall survival or tumour grade. Three of these studies measured the association between a delay of 3 months and the tumour grade, and found a positive correlation between prolonged delay and tumour grade.

Aiono et al., (2000) [50] prospectively reviewed the waiting list of a general surgical unit over a 13-year period. They found that surgeons had no control on the length of the surgical waiting lists in spite of the introduction of the SWAT. They revealed that funding, lack of beds and theatre sessions were the main factors influencing the length of the surgical waiting times, and emphasised that an imbalance between these factors will lead to insufficient beds being available to cater for the theatre sessions created leading to frequent cancellations.

In most Western countries like the UK, for example as a result of this ring-fencing system, which ensures that all elective cases are properly pre-booked and carried out on dedicated theatre lists and at specified times, there is hardly any cancellation of elective surgical cases without a definite clinical reason; and when this happens, the erring departments or hospital trusts are fined by the supervising agencies (personal experience). This system will ensure that, elective surgical cases are adequately catered for and patients do not therefore suffer from the consequences of any delays in intervention. In view of this, healthcare managers and policy makers in Nigeria can adopt a similar system to ring-fence all elective surgical cases, and ensure that these procedures are carried out within a specific time frame to improve the quality of care to patients. However, these measures require adequate planning, funding, staff training and patients' co-operation.


   Conclusion Top


Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. A total of 11/37 (24.5%) of the publications were from OG alone, but these were mostly related to emergency antenatal care rather than surgery. Therefore, more research and initiative needs to be undertaken from all the surgical sub-specialties in order to disseminate this concept of SWAT towards early diagnosis and treatment of elective life-threatening conditions, as well as effective patient care. Adopting this concept will help healthcare managers and policy makers to stream line and ring face resources to cater for non-urgent or semi-urgent cases presenting to our hospitals in Nigeria.

 
   References Top

1.
Frankel S. The natural history of waiting lists - some wider explanations for an unnecessary problem. Health Trends. 1989 May; 21(2):56-58.   Back to cited text no. 1
    
2.
Mills RP, Heaton JM. Waiting list initiatives: Crisis management or targeting of resources? J R Soc Med 1991;84:405-7.  Back to cited text no. 2
    
3.
Casas MJ, Kenny DJ, Barett EJ, Brown L. Prioritization for elective dental treatment under general anesthesia. J Can Dent Assoc. 2007 May;73(4):321.  Back to cited text no. 3
    
4.
Mukherjee S, Fountain G, Stalker M, Williams J, Porrett TR, Lunniss PJ. Homerton Hospital Colorectal Cancer Multidisciplinary Team. The 'straight to test' initiative reduces both diagnostic and treatment waiting times for colorectal cancer: Outcomes after 2 years. Colorectal Dis 2010;12:e250-4.  Back to cited text no. 4
    
5.
Lewis NR, Le Jeune I, Baldwin DR. Under utilisation of the 2-week wait initiative for lung cancer by primary care and its effect on the urgent referral pathway. Br J Cancer. 2005 Oct 17;93(8):905-8.  Back to cited text no. 5
    
6.
Bruni RA, Laupacis A, Levinson W, Martin DK. Public views on a wait time management initiative: A matter of communication. BMC Health Serv Res 2010;10:228.  Back to cited text no. 6
    
7.
Aderounmu AO, Adeoti ML, Oguntola AS, Oboro VO, Fadiora SO, Akanbi OO, et al. Pattern and outcome of emergency surgery in a new Nigerian teaching hospital--The LAUTECH Osogbo experience. Niger Postgrad Med J 2006;13:172-5.  Back to cited text no. 7
    
8.
Adamu A, Maigatari M, Lawal K, Iliyasu M. Waiting time for emergency abdominal surgery in Zaria, Nigeria. Afr Health Sci 2010;10:46-53.  Back to cited text no. 8
    
9.
Orji EO, Fasubaa OB, Onwudiegwu U, Dare FO, Ogunniyi SO. Decision-intervention interval in ruptured uteri in Ile-Ife, Nigeria. East Afr Med J 2002;79:496-8.  Back to cited text no. 9
    
10.
Anonymous. Situation analyses of emergency obstetric care: Examples from eleven operations research projects in west Africa. The prevention of maternal mortality network. Soc Sci Med 1995;40:657-67.  Back to cited text no. 10
    
11.
Anonymous. Reaching help on time in an emergency delivery. Safe Mother 1991:5-7.  Back to cited text no. 11
    
12.
Ariba AJ, Thanni LO, Adebayo EO. Patients' perception of quality of emergency care in a Nigerian teaching hospital: The influence of patient-provider interactions. Niger Postgrad Med J 2007;14:296-301.  Back to cited text no. 12
    
13.
Blaney CL. Access to care save lives. Netw Res Triangle Park N C 1994;14:12-5.  Back to cited text no. 13
[PUBMED]    
14.
Adeyemi SD, de Rocha-Afodu JT. Management of imperforate anus at the Lagos University teaching hospital, Nigeria: A review of ten years' experience. Prog Pediatr Surg 1982;15:187-94.  Back to cited text no. 14
[PUBMED]    
15.
Waaldijk K. The immediate management of fresh obstetric fistulas. Am J Obstet Gynecol 2004;191:795-9.  Back to cited text no. 15
[PUBMED]    
16.
Agbo SP, Oboirien M, Ismail S. Pattern of Surgical abdominal emergencies in Sokoto, Nigeria. Jos J Med 2012;6:22-5.  Back to cited text no. 16
    
17.
Mbah N, Opara WE, Agwu NP. Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: Causes of delay and consequences. Niger J Surg Res 2006;8:69-73.  Back to cited text no. 17
    
18.
Rabiu MM, Muhammed N. Rapid assessment of cataract surgical services in Birnin-Kebbi local government area of Kebbi State, Nigeria. Ophthalmic Epidemiol 2008;15:359-65.  Back to cited text no. 18
    
19.
Tahzib F. An Initiative on vesico-vaginal fistula. Lancet 1989;1:1316-7.  Back to cited text no. 19
[PUBMED]    
20.
Misauno MA, Ojo EO, Uba AF. Laparoscopic paediatric surgery: A potential for paradigm shift in developing countries. Afr J Paediatr Surg 2012;9:140-2.  Back to cited text no. 20
[PUBMED]  Medknow Journal  
21.
Akinyoola AL, Adegbehingbe OO, Ogundele OJ. Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria. Tanzan J Health Res 2008;10:68-72.  Back to cited text no. 21
    
22.
Kolawole IK, Bolaji BO. Surgery and Anaesthesia: Reasons for cancellations of elective surgery in Ilorin. Niger J Surg Res 2002:28-33.  Back to cited text no. 22
    
23.
Dunmade AD, Alabi BS. Day case adenoidectomy: Is it safe? Niger J Clin Pract 2009;12:145-8.  Back to cited text no. 23
[PUBMED]    
24.
Abdur-Rahman LO, Kolawole IK, Adeniran JO, Nasir AA, Taiwo J O, Odi T. Pediatric Day case surgery: Experience from a tertiary health institution from Nigeria. Ann Afr Med 2009;8:163-7.  Back to cited text no. 24
[PUBMED]  Medknow Journal  
25.
Abdulkareem IH. Day case surgery in Nigeria. Niger J Clin Pract 2011;14:383-9.  Back to cited text no. 25
[PUBMED]  Medknow Journal  
26.
Legbo JN, Opara WE. Day-care plastic surgery in Nigeria: Coping with limited resources. Ann Afr Med 2005;4:14-8.  Back to cited text no. 26
    
27.
Onwuanyi ON, Omotosho KA, Habeeb KA. Extraction of Kuntscher (femoral) implant under local anaesthesia: An appraisal of patients tolerance and merits. J Pak Med Assoc 1997;47:153-5.  Back to cited text no. 27
    
28.
Onwuanyi ON, Omotosho HA, Habeeb KA. Removal of femoral Kuntscher nails in selected cases under local anaesthesia. East Afr Med J 1996;73:835-7.  Back to cited text no. 28
    
29.
Ekwempu CC. Uterine aspiration using the Karman cannula and syringe. Trop J Obstet Gynaecol 1990;8:37-8.  Back to cited text no. 29
[PUBMED]    
30.
Agbkwuru EA, Faponle AF, Adesukanmi AR, Ogundoyin O. Practice and acceptance of day-care surgery in a semi-urban Nigerian hospital. East Afr Med J 2001;78:170-3.  Back to cited text no. 30
    
31.
Dakum NK, Ramyil VM, Misauno MA, Ojo EO, Ogwuche EI, Sani AA. Reasons for cancellations of urologic day care surgery. Niger J Surg Res 2006;8:30-3.  Back to cited text no. 31
    
32.
Iliyasu Z, Abubakar IS, Abubakar S, Lawan UM, Gajida AU. Patient's satisfaction with services obtained from Aminu Kano teaching hospital, Kano Nigeria. Niger J Clin Pract 2010;13:371-8.  Back to cited text no. 32
[PUBMED]  Medknow Journal  
33.
Esimai OA, Omoniyi-Esan GO. Wait time and service satisfaction at Antenatal Clinic, Obafemi Awolowo University Ile-Ife. East Afr J Public Health 2009;6:309-11.  Back to cited text no. 33
    
34.
Bamise C, Bada T, Bamise F, Ogunbodede E. Dental care utilization and satisfaction of residential university students. Libyan J Med 2008;3:140-3.  Back to cited text no. 34
    
35.
Ajayi IO, Olumide EA, Oyediran O. Patient satisfaction with the services provided at a general outpatients' clinic, Ibadan, Oyo State, Nigeria. Afr J Med Med Sci 2005;34:133-40.  Back to cited text no. 35
    
36.
Uzochukwu B, Onwujekwe O. Healthcare reform involving the introduction of user fees and drug revolving funds: Influence on health workers' behavior in southeast Nigeria. Health Policy 2005;75:1-8.  Back to cited text no. 36
    
37.
Ademola-Popoola DS, Akande TM, Idris A. Patients' assessment of quality of eye care in a nigerian teaching hospital. Niger Postgrad Med J 2005;12:145-8.  Back to cited text no. 37
    
38.
Ehiri JE, Oyo-Ita AE, Anyanwu EC, Meremikwu MM, Ikpeme MB. Quality of child health services in primary health care facilities in south-east Nigeria. Child Care Health Dev 2005;31:181-91.  Back to cited text no. 38
    
39.
Ajayi IO. Patients' waiting time at an outpatient clinic in Nigeria - can it be put to better use? Patient Educ Couns 2002;47:121-6.  Back to cited text no. 39
[PUBMED]    
40.
Alakija W. Some factors affecting utilization of health services provided for students of the University of Benin, Nigeria. Family Practice. Vol. 5. Oxford: Oxford University Press; 1988.  Back to cited text no. 40
    
41.
Bamisaiye A, Ransome-Kuti O, Famurewa AA. Waiting time and its impact on service acceptability and coverage at an MCH clinic in Lagos, Nigeria. J Trop Pediatr 1986;32:158-61.  Back to cited text no. 41
[PUBMED]    
42.
Gukas ID, Nwana EJ, Ihezue CH, Momoh JT, Obekpa PO. Tru-cut biopsy of palpable breast lesions: A practical option for pre-operative diagnosis in developing countries. Cent Afr J Med 2000;46:127-30.  Back to cited text no. 42
    
43.
Olasinde TA, Handl-Zeller L. Influence of size of primary breast tumour on local control. Afr J Med Med Sci 1993;22:65-8.  Back to cited text no. 43
    
44.
Bruni RA, Laupacis A, Levinson W, Martin DK. Public involvement in the priority setting activities of a wait time management initiative: A qualitative case study. BMC Health Serv Res 2007;7:186.  Back to cited text no. 44
    
45.
Briggs RJ, Smith KM, Dejager EM, Callahan JT, Abernethy JA, Dunn EJ, et al. The active management of surgical waiting lists: A urological surgery case study. Aust Health Rev 2011;35:399-403.  Back to cited text no. 45
    
46.
Mills S. Reducing waiting times in diagnosing patients with endometrial cancer. Cancer Nursing Practice 2005;4:34-5.  Back to cited text no. 46
    
47.
Gray JR, Boland LL, Machemer CH, Nelson MW. Elimination of excess preoperative wait time and its impact on immediate clinical outcomes among patients undergoing spinal surgery. J Nurs Care Qual 2010;25:248-54.  Back to cited text no. 47
    
48.
Jewett M, Rendon R, Dranitsaris G, Drachenberg D, Tanguay S, Donnelly B, et al. Canadian surgical wait times (SWAT) initiative. Does prolonging the time to renal cancer surgery affect long-term cancer control: A systematic review of the literature. Can J Urol 2006;13 Suppl 3:54-61.  Back to cited text no. 48
    
49.
Fradet Y, Aprikian A, Dranitsaris G, Siemens R, Tsihlias J, Fleshner N. Canadian surgical wait times (SWAT) initiative. Does prolonging the time to bladder cancer surgery affect long-term cancer control: A systematic review of the literature. Can J Urol 2006;13 Suppl 3:37-47.  Back to cited text no. 49
    
50.
Aiono S, Faber RG, Galland RB. Surgeons have little control over general surgical waiting lists. Ann R Coll Surg Engl 2000;82 (9 Suppl):304-7.  Back to cited text no. 50
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed2530    
    Printed31    
    Emailed0    
    PDF Downloaded186    
    Comments [Add]    

Recommend this journal