OK We use cookies to enhance your visit to our site and to bring you advertisements that might interest you. Read our Privacy and Cookies policies to find out more.
OK We use cookies to enhance your visit to our site and to bring you advertisements that might interest you. Read our Privacy and Cookies policies to find out more.

News Americas

According to latest research, the risk of death is one-third lower for patients with short delays in undergoing CABG surgery, compared with those with excessive delays. (Photo: Condor 36/Shutterstock)
Aug 9, 2012 | News Americas

Long waiting times for heart bypass surgery linked to higher death risk

by Surgical Tribune

VANCOUVER, Canada: In the Canadian health-care system, patients with longer than recommended waitlist times for coronary artery bypass graft (CABG) surgery are at increased risk of dying in hospital, researchers have found. According to their study, the risk of death is one-third lower for patients with short delays in undergoing CABG surgery, compared with those with excessive delays.

Researcher Dr. Boris G. Sobolev and his colleagues at the University of British Columbia analyzed data on approximately 9,600 patients who had undergone CABG surgery in British Columbia between 1992 and 2006. All procedures were performed on an elective basis — that is, not as an urgent or emergency procedure — once the patient had been registered on a waitlist.

Waitlist time was analyzed for association with the risk of in-hospital death, accounting for the role of other known risk factors. Risk was compared for patients with short delays (within two weeks for semiurgent and six weeks for nonurgent procedures, as recommended by the Canadian Cardiovascular Society), prolonged delays (within six to 12 weeks, as recommended by British Columbia provincial guidelines), and excessive delays (longer than either set of recommendations).

Overall, about 12.5 percent of patients had short delays before undergoing CABG surgery, 21.5 percent had prolonged delays, and 66 percent had excessive delays. Patients with shorter delays tended to be sicker and to have more risk factors.

The absolute risk of in-hospital death was relatively small: 1.2 percent. However, risk increased from 0.6 percent for patients with short delays to 1.1 percent for those with prolonged delays and to 1.3 percent for those with excessive delays.

When other risk factors were taken into account, the possibility of death was about two-thirds lower for the patients with short versus excessive delays. There was no significant difference in risk for patients in the prolonged delay category.

In the Canadian health-care system and similar systems, limited capacity requires budgeting the number of CABG surgeries (and other complex procedures) within a given time. Guidelines for CABG waitlist times were made on the basis of expert opinion, with "little evidence to support the recommended target times," according to the authors.

The new study supports the stricter CCS timeframe guidelines for performing elective CABG surgery. "We found that among patients who underwent the operation within the CCS target times, in-hospital death was one-third as likely among those who had to wait longer than provincial guidelines," Sobolev and colleagues state. However, they note that two-thirds of patients had waiting times exceeding even the less-stringent provincial guidelines.

Sobolev and colleagues believe their study provides evidence to inform decisions regarding capacity planning versus access time for CABG surgery, with the goal of minimizing adverse outcomes associated with excessive delays. The results also have implications for other models of government-sponsored medicine providing universal coverage for eligible patients, including the the U.S. Department of Veterans Affairs' administration system.

The study "An Observational Study to Evaluate 2 Target Times for Elective Coronary Bypass Surgery" was published in the July issue of the Medical Care journal.

RELATED ARTICLES
Print  |  Send to a friend