Surgical standby for percutaneous transluminal coronary angioplasty: a survey of patterns of practice.
To determine patterns of surgical standby for percutaneous transluminal coronary angioplasty (PTCA), a questionnaire was mailed to 196 US institutions in which PTCA and coronary artery bypass grafting (CABG) are performed regularly. Eighty-nine responses (46%) were received and comprise this report. Of responding institutions, the mean number of hospital beds was 615. In 1987, these institutions performed a mean of 337 PTCAs and 558 open-heart surgical procedures. The rate of emergency CABG for PTCA complications (occlusion, dissection, or coronary perforation) was 4.4% +/- 0.3%, whereas the rate of urgent CABG (within 24 hours) for PTCA failure was 3.7 +/- 0.6%. The incidence of emergency CABG for PTCA complications was higher (5.1% +/- 0.6%) among low-volume PTCA centers (less than 250 cases per year) than at high-volume centers (more than 250 cases per year) (3.7% +/- 0.3%; p less than 0.05). The most common pattern of surgical backup was to maintain an open operating room on standby (57/89, 64%), and the second most common pattern was to make the next open operating room available, allowing operating room access within 1 to 3 hours (21/89, 24%). Nearly a third of institutions (26/89, 29%) maintained a flexible backup arrangement according to PTCA risk. Routine pre-PTCA patient evaluation by surgeon and/or anesthesiologist occurred in 38% (34/89). Fees for standby services were charged by 51% of surgical teams (45/89), 39% of anesthesia teams (35/89), and 38% of operating room facilities (34/89).(ABSTRACT TRUNCATED AT 250 WORDS)
Cameron
D E
DE
Johns Hopkins Medical Institutions, Baltimore, Maryland.
Stinson
D C
DC
Greene
P S
PS
Gardner
T J
TJ
D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003258:Consumer Behavior; D001026:Coronary Artery Bypass / Q000191:economics / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D003365:Costs and Cost Analysis; D004630:Emergencies; D006742:Hospital Bed Capacity; D006801:Humans; D010818:Practice Patterns, Physicians'; D012307:Risk Factors