Abstract
BackgroundIn deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation.MethodsThe study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models.ResultsUrgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02–2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54–1.04) vs. 0.58 (95% CI 0.42–0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01–2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month.ConclusionLong wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.
Highlights
In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients
A patient who presents with the symptoms of coronary artery disease (CAD) is usually referred to a cardiologist, who evaluates the results of coronary angiography and recommends treatment
Death certificates were available for 87 of the 92 patients who died while awaiting operation, and 5 sudden deaths were reported by the participating hospitals
Summary
In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. If coronary angioplasty is not indicated, that patient is referred to a cardiac surgeon, who assesses the need for and suitability of CABG surgery. Elective patients are scheduled for outpatient consultation with the cardiac surgeon. After the consultation in which a CABG is deemed necessary, surgeons register patients on their wait lists. Surgical wait lists hold patient names until surgery can be scheduled. Patients are removed from the wait list without having undergone surgery if they die, refuse the operation, accept surgery from another surgeon, move out of the province, or experience a health-related decline that contraindicates surgery
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