A prospective study to evaluate access to elective surgical services in a urology unit of Sri Lanka

Introduction One of the core indicators of monitoring universal access to safe, affordable surgical care is access to timely, essential surgery. Analysing the waiting time for elective operations is one way to determine access to surgical services in a country. Aims of this study were to determine the access to surgical services in a urology unit of Sri Lanka by analysing waiting time for elective surgical operations and to determine whether waiting time is related to income categories and social classes. Methodology All patients undergoing surgery (excluding emergency and elective minor surgery) at a urology unit between 01.01.2016 to 30.04.2017 were included in the study. The income groups were categorised according to the household income and receipt of Samurdhi benefit. Waiting time was the period between the day the decision was taken for surgery and the day of surgery. Results A total of 1079 patients had complete data and 845 (78.3%) were men. Median waiting time for surgery was 40 days. Eighty nine (8.2%) were Samurdhi beneficiaries and their median waiting time was 48 days. Two hundred and nineteen (20.3%) operations were done for malignancies and the median waiting time was 20 days. Median waiting time for TURP and renal stone surgery were 55 and 125 days respectively. One hundred and seventy (15.8%) patients had their operations postponed at least once. Survival analysis showed that there is no statistically significant difference between the waiting time with income levels (p=0.38) and recipient status of Samurdhi (p=0.29). Conclusion Waiting time for elective urological surgery is too long though waiting time for malignancies is satisfactory in the unit. Socioeconomic status of the patient has no statistically significant influence on the waiting time indicating equity in the unit policy.