Waiting for cardiac surgery: results of a risk-stratified queuing process.
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.


RESULTS
Analysis was performed for 2102 consecutive patients queued for CABG, aortic valve replacement, or CABG+aortic 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 (P=0.001). The incidence of postoperative complications was 25.0%, and operative mortality was 2.86%. Both were more frequent among patients undergoing surgery early (P=0.01); 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.
Ray
A A
AA
Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Centre, Faculty of Medicine Dalhousie University, Halifax, Nova Scotia, Canada.
Buth
K J
KJ
Sullivan
J A
JA
Johnstone
D E
DE
Hirsch
G M
GM
D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000592:standards*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000592:standards; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000592:standards; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D009674:Nova Scotia / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists