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

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Surgical Outcomes

Background:

• A weekly peer-review conference prioritizes cardiovascular surgical cases using standardized criteria.
• The study examines the risks associated with waiting for surgery and its impact on patient outcomes.

Purpose of the Study:

• To evaluate the hazard of waiting for cardiac surgery.
• To assess the impact of waiting times on surgical outcomes for patients undergoing CABG, aortic valve replacement, or both.

Main Methods:

• Analysis of 2102 consecutive patients queued for cardiac surgery between 1998 and 1999.
• Tracking of waiting times, urgent status upgrades, in-hospital deaths, postoperative complications, and length of stay.

Main Results:

• Median waiting times ranged from 8 days (in-house urgent) to 113 days (elective).
• 13 deaths (0.7%) occurred during the waiting period; 8.7% of patients were upgraded, with 86.1% requiring pre-surgery hospitalization.
• Postoperative complications (25.0%) and operative mortality (2.86%) were higher in patients undergoing surgery earlier, primarily from the in-house urgent queue. Length of stay was unaffected by waiting time.

Conclusions:

• Deaths and upgrades during the waiting period typically occurred early.
• Prolonged waiting times were not associated with worse surgical outcomes.
• Reducing waiting times could offset costs by preventing pre-surgery hospital admissions.