Waiting for coronary artery bypass surgery: population-based study of 8517 consecutive patients in Ontario, Canada

Cd, Naylor; Sykora, Kathy; Jaglal, Susan; Jefferson, Salas

doi:10.1016/s0140-6736(95)91934-1

Cited by 88 publications

(64 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This observation was consistent with similar findings by Naylor et al 4 Additionally, adverse events were distributed among all queues, indicating our inability to adequately risk-stratify patients before surgery. One possibility is that risk stratification could be improved by taking into account factors important in predicting surgical outcomes, such as ejection fraction, prior CABG, history of myocardial infarction, and history of congestive heart failure.…”

Section: Discussionsupporting

confidence: 93%

Waiting for Cardiac Surgery

Ray¹,

Buth²,

Sullivan³

et al. 2001

Circulation

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 93%

Waiting for Cardiac Surgery

Ray¹,

Buth²,

Sullivan³

et al. 2001

Circulation

View full text Add to dashboard Cite

show abstract

“…Two large, retrospective studies (44,45) from Ontario registries, involving 37,810 patients in total, have reported a waiting list mortality of less than 0.5%. In their study of 29,293 patients, Morgan et al (44) reported that patients waiting for CABG alone had a mortality rate of 0.4%, with onethird of deaths occurring within the first two weeks and the rest being randomly spaced through all time intervals, even beyond three months.…”

Section: Safety Issues Related To Surgical Delaymentioning

confidence: 99%

Timing of bypass surgery in stable patients after acute myocardial infarction

Raghavan

Benzaquen

Rudski

2007

Canadian Journal of Cardiology

View full text Add to dashboard Cite

R Raghavan, BS Benzaquen, L Rudski. Timing of bypass surgery in stable patients after acute myocardial infarction. Can J Cardiol 2007;23(12):976-982.OBJECTIVES: To determine the optimal timing for bypass surgery in stable patients after acute myocardial infarction (MI). BACKGROUND: Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. Because of the hypothesized risk of hemorrhagic transformation, it had become common practice to wait four to six weeks after MI. Recently, improvements in surgical and perioperative management, as well as an increase in pre-CABG in-hospital waiting times and excess burden on health care resources, have pushed surgeons to operate earlier. The optimal timing for a stable patient to undergo CABG after MI is unclear, because there have been no randomized trials to answer this question. METHODS:The published literature comparing early versus late surgical revascularization procedures in stable post-MI patients was reviewed. RESULTS: No randomized, prospective trials were found; however, several retrospective studies were identified. Most series examining Q wave MIs showed that mortality is higher in the early stages post-MI and progressively decreases with time post-MI. When studies examined non-Q wave MIs separately, there appeared to be less of a mortality difference between early and late surgical revascularization. There was a large disparity between the definitions of early surgery post-MI among the studies, some as early as 6 h and others up to eight days. Factors that increased mortality include abnormal left ventricular function and urgency of surgery, and some studies found risk models helpful to define increased risk after infarction. The possible increased risk of early surgery may be balanced against the potential for improved remodelling, improved quality of life and decreased hospital stay costs. CONCLUSIONS: There is a need for a randomized, prospective trial examining the optimal timing for CABG in stable post-MI patients.

show abstract

“…Although the number of patients requiring surgery is increasing sharply, restricted capacity for CABG results in waiting before surgery. Even in developed countries there is a waiting list for CABG which can have adverse effects on the patients concerned through increased risk of death and other ischemia related events, as well as decrease in quality of life and increase in costs (Bass 1984;Horgan et al 1984;Bryant and Mayou 1989;Dupuis et al 1990;Naylor et al 1995). To minimize morbidity and mortality related to waiting, patient's need for surgery is assigned to certain priority and the patient is subsequently placed at one of several points along the queue (Naylor et al 1990(Naylor et al , 2000Agnew et al 1994).…”

Section: Study Protocolmentioning

confidence: 99%

Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

Sarı

Acar

Nurkalem

et al. 2007

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Contoversy exists about the optimal operation time of the patients with left main coronary artery (LMCA) stenosis. We therefore, aimed to investigate the effect of waiting time on in-hospital morbidity and mortality in patients with LMCA stenosis and identify the risk factors associated with adverse cardiovascular events before and during surgery. One hundred seventy six patients with LMCA stenosis were divided into two groups according to the time period between coronary angiography and coronary artery bypass surgery (group 1: 7 days, 94 patients; and group 2: > 7 days, 82 patients). Primary end points were death and major adverse cardiac event (MACE): in-hospital death, sustained ventricular tachycardia or ventricular fibrillation development, postoperative stay in the intensive care > 48 hrs and in hospital > 9 days. Demographic and clinical characteristics of patients in groups 1 and 2 were comparable. There was no difference between the two groups in terms of in-hospital morbidity, mortality and MACE. When we analyzed the differences between the patients with and without MACE, the patients who experienced MACE were older ( p = 0.001), and had higher degree of LMCA stenosis ( p = 0.01), higher degree of right coronary artery stenosis ( p = 0.02), higher blood urea level ( p = 0.003), and higher incidence of unstable angina or myocardial infarction within 2 weeks ( p = 0.001). Independent risk factors for MACE were unstable angina or myocardial infarction within 2 weeks, age more than 70 years and stenosis more than 75% in the LMCA. These results suggest that preoperative clinical status but not waiting time predicts in-hospital surgical outcomes in LMCA stenosis.left main coronary artery stenosis; surgery; waiting time

show abstract

Waiting for coronary artery bypass surgery: population-based study of 8517 consecutive patients in Ontario, Canada

Cited by 88 publications

References 12 publications

Waiting for Cardiac Surgery

Waiting for Cardiac Surgery

Timing of bypass surgery in stable patients after acute myocardial infarction

Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

Contact Info

Product

Resources

About