Estudio para el establecimiento de un sistema de priorización de pacientes en lista de espera para cirugía de varices

Summary. Introduction and aims. Waiting lists that are managed by the 'first in-first served' criterion may give rise to clinical, social or ethical inequalities. Our aim is to establish an objective, fair system of prioritising varicose vein surgery. Subjects and methods. Based on the 'conjoint analysis'methodology, one focus group patients were arranged in strata according to age and clinical disorder, and another was organised with specialists in Angiology and Vascular Surgery and managers from the sponsoring hospital. The opinions of each collective were determined and a preliminary system was set up with the selected criteria. The categories were weighted with personal interviews held with 104 randomly-chosen subjects from the general population. The preferences were estimated by means of the ordered logit multivariate parametric regression technique. The values of the parameters were normalised on a scale from 0 to 100. Results. The final prioritisation system was: severity of the pathology (according to the CEAP scale): mild (C2) 0 points, moderate (C3-C4) 18 points, severe (C5-C6) 42 points; compromise of quality of life (CIVIQ-2 survey): mild (CIVIQ-2 > 65) 0 points, moderate (CIVIQ-2 ≥ 30 and ≤ 65) 9 points, severe (CIVIQ-2 < 30) 19 points; with no aggravating occupational circumstances 0 points and 17 points with such circumstances; size of the varicose veins: small (< 10 mm) 0 points and large (≥ 10 mm) 9 points. Conclusions. The resulting system for arranging a waiting list in order of priority takes into account an integrated vision by specialists, managers, patients and the general population, and includes criteria such as the severity of the pathology, quality of life, the presence of complications, aggravating occupational circumstances and the size of the varicose veins. [ANGIOLOGIA 2008; 60: 333-45]