title: Outcome of rationing access to open-heart surgery: effect of the wait for elective surgery on patient outcome.
abstract: OBJECTIVE
  To assess the effect of the waiting period before elective open-heart surgery on patient outcomes.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  The Montreal Heart Institute, a referral centre in cardiology and cardiac surgery.
  
  
  METHODS
  All 568 patients who underwent open-heart surgery on an elective basis or following urgent admission or interhospital transfer between October 1991 and February 1992.
  
  
  METHODS
  In-hospital death rate, incidence of postoperative complications, length of stay in the intensive care unit (ICU) and total length of hospital stay.
  
  
  RESULTS
  A total of 206 patients (151 men and 55 women with an average age of 59.0 [standard error of the mean (SEM) 1] years) underwent elective surgery, and 362 patients (264 men and 98 women with an average age of 62.0 [SEM 1] years) underwent urgent surgery. The mean wait for elective surgery was 2.8 (SEM 0.2) months. There was no significant difference between the two groups in the in-hospital death rate (4% v. 4%), the average length of stay in the ICU (4.4 [SEM 0.2] days v. 5.8 [SEM 1] days) or the average total length of hospital stay (9.0 [SEM 0.4] days v. 9.1 [SEM 1] days). As would be expected, postoperative complications developed in significantly more patients in the urgent group (27%) than the elective group (18%) (p = 0.02). Eight patients were admitted on an urgent basis for surgery owing to worsening symptoms or acute myocardial infarction after a mean wait of 4.6 months. One patient died suddenly at home 1 month after medical investigation while awaiting repeat coronary artery bypass grafting. Among the 206 patients who underwent elective surgery there was no relation between waiting time and adverse clinical outcomes after surgery.
  
  
  CONCLUSIONS
  The results suggest that the wait before elective open-heart surgery had no effect on patient outcome after surgery in our institution. A policy of a short waiting period before elective open-heart surgery for patients whose condition is stable is safe and acceptable only if rapid access to medical and surgical treatment is available should it become necessary.
authors.affiliation: Department of Surgery, Montreal Heart Institute, Que.
authors.forename: M
authors.initials: M
authors.lastname: Carrier
authors.forename: R
authors.initials: R
authors.lastname: Pineault
authors.forename: N
authors.initials: N
authors.lastname: Tremblay
authors.forename: L C
authors.initials: LC
authors.lastname: Pelletier
mesh_terms: D000704:Analysis of Variance; D002300:Cardiac Care Facilities; D006348:Cardiac Surgical Procedures; D017558:Elective Surgical Procedures; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014850:Waiting Lists