ORIGINAL ARTICLE Surgical waiting times and patient choice: How much delay do patients really want? Vivak Chander Hansrani • Angus Fong • Nicholas Ferran • Stephen Williams Received: 15 January 2014 / Accepted: 30 March 2014 Ó Springer-Verlag France 2014 Abstract Background The 18-week target to treatment government initiative was implemented in 2004. In order for this to work, patients need to accept operative dates provided, otherwise the pathway will fail. Aim The aim of this prospective study was to identify the earliest time patients would accept surgical intervention following assessment at an outpatient clinic and to identify the reasons why some patients would choose to delay surgery. Methods This prospective study was carried out at an elective orthopaedic centre over a 5-month period. All new adult referrals to the department were asked to complete a seven-point questionnaire on waiting time preference and possible reasons for delaying surgery. No paediatric or spinal orthopaedics was carried out at the centre. Results A total of 73 % of the 797 questionnaires were completed. Up to 16 % of patients could not accept day- case/inpatient operation within 6 weeks. Work commit- ment was the most common reason for choosing to delay surgery, with nearly 50 % of employed patients citing it as a reason. No significant difference was identified between inpatient and day-case procedures. Conclusion There is a risk that operative slots will be unfilled within the 18-week pathway. 18 % of patients will potentially refuse an operative date offered within 6 weeks of their outpatient visit. Work, holidays and care arrange- ments are important in uptake. A proactive strategy to improve the uptake of offered surgery is required to pre- vent operating slots being underutilised. Keywords Elective surgery Á Orthopaedic surgery Á Waiting times Á Patient choice Introduction Since the inception of the National Health Service (NHS), it has been plagued with growing waiting times. Often used as an instrument for rationing the demand for health care, successive governments have made several attempts at improving access to services [1]. It was not until 1999 that waiting times began to fall with the introduction of treat- ment centres for elective surgery [2, 3]. In 2004, the renewed NHS improvement plan stated that ‘by 2008, no one will have to wait longer than 18 weeks for hospital treatment from GP referral’ [4]. Under the current initia- tive, patients are placed on an elective surgery waiting list after a lengthy process of referral, specialist assessment and investigation. Patients placed on a waiting list have been assessed to have a clinical need for surgery. However, with increased emphasis on patient choice and information transparency, the current method of treatment allocation is outdated. Patients are increasingly taking into consideration what the impact surgery could potentially have on their health, employment and social life. Under- going elective surgery within 18 weeks of referral is not convenient for all patients. Up to 13 % of patients offered V. C. Hansrani (&) Á A. Fong Á N. Ferran Á S. Williams Musculoskeletal Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester LE3 9QP, UK e-mail: vchansrani@doctors.org.uk A. Fong e-mail: Angus.fong@doctors.org.uk N. Ferran e-mail: nferran@uku.co.uk S. Williams e-mail: Stephen.williams@uhl-tr.nhs.uk 123 Eur J Orthop Surg Traumatol DOI 10.1007/s00590-014-1460-x