Waiting for Cardiac Surgery

Abstract

Background-The Queen Elizabeth II Health Sciences Centre uses a weekly peer-review conference of cardiovascular experts to prioritize each surgical case to 1 of 4 queues with the use of standardized criteria of coronary anatomy, stress test result, and symptoms. We examined the hazard of waiting as well as the impact of waiting on surgical outcomes. Methods and Results-Analysis was performed for 2102 consecutive patients queued for CABG, aortic valve replacement, or CABGϩaortic valve replacement between January 1, 1998, and December 31, 1999. Among 1854 patients undergoing surgery, median waiting times on the respective queues were as follows: in-house urgent group, 8 days; semiurgent A group, 37 days; semiurgent B group, 64 days; and elective group, 113 days. There were 13 deaths (12 cardiac) that occurred during the waiting period (0.7% of the patients). Of the 8.7% patients upgraded to a more urgent queue, 86.1% required hospitalization before surgery. Although female sex was not associated with prolonged waiting time, it was predictive of urgent status (Pϭ0.001). The incidence of postoperative complications was 25.0%, and operative mortality was 2.86%. Both were more frequent among patients undergoing surgery early (Pϭ0.01); however, this difference was attributable to the in-house urgent queue. The median length of stay was 7 days for all patients and was not affected by waiting time. Conclusions-Death and upgrades while the patients were waiting tended to occur early in the queuing process, and prolonged waiting was not associated with worse surgical outcomes. The cost of reducing waiting times could in part be offset by prevention of hospital admissions among upgraded patients.

Post-surgery survival and associated factors for cardiac patients in Ethiopia: applications of machine learning, semi-parametric and parametric modelling

“…However, some papers stated that the surgery outcome was not related to the waiting time [78]. Another study stated that Prolonged waiting was not associated with worse surgical outcomes [79]. Those studies contradicted the study just due to the study area with a lower waiting time unlike to developing country Ethiopia.…”

Severe myocardial ischemia in a patient with diabetes mellitus and left bundle branch block

“…Most adverse events happen very early in the waiting process, usually within the first 30 days. 20,21 The most common, and likely prognostic, risk factor is unstable angina prior to diagnostic angiography. 20 Other factors associated with death while awaiting CABG include positive exercise testing, smoking, severe LM or 3-vessel disease, LV dysfunction, NYHA functional class, and triglyceride level.…”

The workload, outcome and waiting time of cardiothoracic operations: a single unit study in Sri Lanka

“…According to the World Health Organization [WHO], cardiovascular diseases caused 17.9 million deaths globally in 2016 [2]. Given that resources to treat heart disease -especially with operative procedures such as Coronary Artery Bypass Grafting [CABG] are not unlimited -the workload, outcome and state of the waiting lists for cardiothoracic operations are of concern to both the public and medical professionals all over the world [3]. In Sri Lanka too, the escalating number of patients in waiting lists across the cardiothoracic units in the country is a hot topic of discussion in clinical circles as well as the media [4,5].…”