785 Countdown to Lobectomy: Interventions to Reduce Waiting Times in Lung Cancer Surgery

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Abstract Aim To evaluate and improve adherence to regional guidance for wait times in lung cancer lobectomy through targeted quality improvement measures. Method A three-cycle prospective analysis of electronic care records (n=86) was conducted over two years. Interventions included the introduction of joint thoracic-oncology clinics with clinic and operative pooling (cycles 1-2), followed by a reorganisation of thoracic services (cycles 2-3). Primary outcomes were: i) time from referral to lobectomy (62-day target) and ii) time from decision to treat (DTT) to lobectomy (31-day target). Secondary outcomes included wait times for preoperative investigations (CT/PET/biopsy) and outpatient assessment. Post-Lasso regression was performed to identify predictors of 62-day waits for future intervention. Results The mean interval from referral to lobectomy decreased from 120.47 (±32.84) to 109.67 (±28.80) days following the introduction of joint clinics and pooling initiatives (t(31.85)=3.01, p=0.005, dR=0.55). No improvements were achieved by service reorganisation (p>0.05). Neither intervention engendered change between DTT and lobectomy (31-day target), suggesting that improvements in 62-day targets may be driven by upstream factors. Post-Lasso regression (R2=0.94) revealed that shorter waits to PET (β=0.18), preoperative biopsy (β=0.17), and faster turnarounds from DTT to surgery (βDTT-OPC=0.91; βOPC-Surgery=0.87), were strongly predictive of shorter waits to surgery (ps<0.05). Conclusions Despite improvements, waiting times remain well above targets. Expediting preoperative investigations and outpatient assessments may ameliorate delays. While it is important to optimise all components of the pathway, the post-DTT period may represent the greatest opportunity for impactful intervention, as delays during this phase were most strongly predictive of overall wait.

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