title: Changes in referral protocols for cardiac surgery: do financial considerations come at a cost?
abstract: OBJECTIVE
  The aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times, hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery.
  
  
  METHODS
  In this retrospective study of patients referred for cardiac surgery between January 1, 2008 and September 30, 2014, the study population was divided into two groups: those referred before (group A, January 1, 2008 to August 31, 2011) and after (group B, September 1, 2011 to September 30, 2014) the change in referral protocols. A telephone follow-up was conducted.
  
  
  RESULTS
  There were 864 patients referred for cardiac surgery, 557 in group A and 307 in group B. Patient characteristics were similar between groups. The mean waiting time for surgery was 10.6±18.5 days and 55.7±79.9 days in groups A and B, respectively (p=0.00). During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0:00); mortality was, respectively, 0% and 2.3% (p=0.00). During one-year follow-up 12.8% of group A patients and 16% of group B patients were hospitalized. Cardiovascular mortality in this period was around 5% in both groups (p>0.05).
  
  
  CONCLUSIONS
  Changes to referral protocols for cardiac surgery had an impact on waiting times, on the number of hospitalizations and on mortality in this period.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal. Electronic address: pina_amado@hotmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Amado
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Dina
authors.initials: D
authors.lastname: Bento
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Daniela
authors.initials: D
authors.lastname: Silva
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Chin
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Marques
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Gago
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mimoso
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Ilídio
authors.initials: I
authors.lastname: de Jesus
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000191:economics* / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality
keywords: Cardiac surgical procedures; Follow‐up; Listas de espera; Mortalidade; Mortality; Procedimentos cirúrgicos cardíacos; Seguimento; Waiting lists