Evaluation of referral pathways for coronary artery bypass surgery patients; comparison on clinical outcomes, quality of life and process parameters

Abstract

Objective To compare clinical outcomes, quality of life and process parameters of coronary artery bypass grafting (CABG) patients treated in a regional hub-and-spokes network. Methods Data from patients who underwent elective CABG from 2016 to 2020 at a Dutch heart center ('hub') were grouped by referral pathways by the cardiologist: internal (A) and four external (B–E). Clinical outcomes, quality of life, and process parameters were evaluated. Results In 690 CABG patients, no significant differences in baseline characteristics and clinical outcomes between care pathways were revealed. Hub-treated patients had shorter median hospital (7 days, IQR 6–8; p<.01) and preoperative stays (1 day, IQR 1–1; p<.01) compared to those treated at spokes. Within 8 weeks, 97.2% had outpatient visits, with pathways A, C, and E attending more frequently than B and D. Time to first visit ranged from 31–44 days. Cardiac rehabilitation began at 6 weeks for 40.4% of patients, with higher rates in Pathways B and D (66.4% and 50.0%) compared to the hub, C, and E (27.2% and 33.7%; p<0.001). Conclusion The study revealed notable variations in process parameters among different care pathways within a hub-and-spoke model for CABG patients, while maintaining comparable clinical outcomes and quality of life.