Surgical waiting times in patients with high‐ and low‐risk renal cell carcinoma in England

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Abstract
Objectives: To assess to what extent hospitals meet the uniform English National Health Service ‘timely’ treatment standard, what happens after a breach, and determinants of delay for patients with high‐risk renal cell carcinoma (RCC). Patient and Methods: Population‐based study using linked data for 7030 patients with high‐risk and 10 708 patients with low‐risk RCC, 2019–2023. The probabilities of ‘timely’ treatment and prolonged delay (≤31 days or >62 days from decision‐to‐treat, respectively) were estimated using multilevel logistic regression. Daily treatment probabilities beyond 31 days were represented using smoothed hazard rates. Results: For a typical patient with high‐risk RCC, timely treatment declined from 83.7% (2019) to 64.8% (2023), with a corresponding decline in the low‐risk group from 71.3% to 47.6%, while prolonged delays more than doubled, from 3.9% to 9.4%. Patients with high‐risk RCC were prioritised over those with low‐risk disease (73.6% vs 58.2%; adjusted risk ratio 1.26, 95% confidence interval 1.22–1.31). Older and more socioeconomically deprived patients experienced longer delays. Once the standard was breached, the daily probability of surgery declined sharply. Adjusted percentages of patients with high‐ and low‐risk RCC treated within the standard were strongly correlated ( r = 0.78). Conclusion: Prioritisation of patients with high‐risk RCC was maintained throughout the study period but did not prevent a system‐wide decline in timely treatment. Patients who breach the timely treatment standard face diminishing daily probabilities of surgery. Risk‐stratified standards, ring‐fenced surgical capacity, and monitoring beyond defined timely treatment standards are needed to safeguard patients against delays that have significant prognostic implications.

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