Managed delay for coronary artery bypass graft surgery: The experience at one Canadian center

Abstract

This triage system equitably stratified patients to a queue. Deaths were rare and could not be attributed to the triage process. Patients with worsening clinical status were safely accommodated with earlier waiting times, but concerns remain regarding excessive waiting times and patient anxiety.

Assessing the risk of waiting for coronary artery bypass graft surgery among patients with stenosis of the left main coronary artery

“…The triage system used has previously been shown to be equitable for most patients waiting for CABG surgery and to result in few adverse events during the wait. 8,11 In our study, the overall mortality of less than 1% among patients waiting for CABG and the postoperative mortality of 5% were consistent with previous reports for patients waiting for CABG in Canada, where managed delays are the norm. 6,8,11,13 Our findings contrast with others that have suggested that stenosis of the left main coronary artery may be associated with an increased risk of death.…”

“…8,11 In our study, the overall mortality of less than 1% among patients waiting for CABG and the postoperative mortality of 5% were consistent with previous reports for patients waiting for CABG in Canada, where managed delays are the norm. 6,8,11,13 Our findings contrast with others that have suggested that stenosis of the left main coronary artery may be associated with an increased risk of death. 4,14 However, many of these studies were limited by their small size (n = 56-90).…”

“…Standard waiting times for these queues are as follows: emergent, no delay (0 days); in-hospital urgent, 7 days; outof-hospital semi-urgent A, 21 days; and out-of-hospital semi-urgent B, 56 days. 8,11 The 343 patients (61.1%) in the in-hospital urgent group had a median wait time of 2 days (interquartile range 0-6 d); 46 (13.4%) waited longer than the standard waiting time of 7 days, and 31 (9.0%) had been upgraded from a less urgent queue. Overall, 147 patients (26.2%) waited longer than the standard; 52 (9.3%) were upgraded to a more urgent queue while they were waiting.…”

“…Individual patients were assigned to a waiting queue on the basis of objective criteria, as previously described. 8,11 The criteria comprised 2 major determinants (anatomy of coronary artery disease and symptom severity) and 2 minor determinants (left ventricular function and results of noninvasive testing). Patients were assigned to 1 of 4 queues: "emergent," "in-hospital urgent," "out-of-hospital semiurgent A" and "out-of-hospital semi-urgent B."…”

“…With the system, patients are assigned to 1 of 4 waiting queues according to their clinical symptoms, stress test results and cardiac anatomy. 8,11 …”