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Published on: May 21, 2017
True versus reported waiting times for valvular aortic stenosis surgery
Brad I Munt1, Karin H Humphries, Min Gao
1Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver. bmunt@providencehealth.bc.ca
Insights
True waiting times for aortic stenosis surgery in British Columbia are significantly longer than reported. The study proposes a new definition for cardiovascular surgery wait times, encompassing the entire patient journey from initial medical contact to surgery.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Public Health
Background:
- Current definitions of surgical waiting times may not accurately reflect patient experience.
- Accurate waiting time metrics are crucial for healthcare system evaluation and patient management.
Purpose of the Study:
- To establish a universally accepted definition for cardiovascular surgery waiting times.
- To compare actual waiting times for aortic stenosis surgery in British Columbia using a new definition versus the current one.
Main Methods:
- Retrospective data analysis of patients undergoing aortic valve surgery for aortic stenosis in British Columbia (1991-2000).
- Data sourced from British Columbia Cardiac Registries and Medical Services Plan databases.
- Calculation of 'true' waiting times from initial physician contact to surgery.
Main Results:
- The true median waiting time was 243 days, 3.2 times longer than the currently reported 75 days.
- 39 patients died while awaiting surgery.
- Patients utilized more healthcare resources during the waiting period than post-surgery.
Conclusions:
- Actual waiting times for aortic stenosis surgery in British Columbia are substantially underestimated.
- A proposed definition for cardiovascular surgery wait time is the interval from the patient's first relevant medical contact to the date of surgery.
Objectives:
To produce a universally accepted waiting time definition for cardiovascular surgery, present the rationale for this definition, and compare data on current waiting times in British Columbia based on this definition versus the current definition in patients waiting for aortic stenosis surgery.
Study Design:
The present study is a retrospective data analysis.
Setting:
The fixed-dollar, single-payer health care delivery system in British Columbia.
Patients:
All residents of British Columbia who were at least 22 years of age and who were placed on a waiting list for aortic valve surgery with the diagnosis of aortic stenosis between January 1, 1991, and December 31, 2000, were eligible for the present study.
Interventions:
Dates of physician visits, procedures and surgery were obtained from the British Columbia Cardiac Registries and Medical Services Plan databases. True waiting times from physician visits to procedures and surgery were calculated.
Results:
Of the 2516 patients booked for aortic valve surgery with a primary diagnosis of aortic stenosis, 2237 subjects (88.9%) were eligible for analysis after exclusions. The eligible patients ranged in age from 22 to 95 years, and 36.8% were female. The true median waiting time was 243 days (148 days [25th percentile], 397 days [75th percentile]), which was 3.2 times the interval currently reported as the waiting time (75 days [42, 127]). Thirty-nine patients died while waiting for surgery. Patients used more resources while waiting for surgery than after surgery.
Conclusions:
True waiting times for surgery for aortic stenosis in British Columbia are significantly longer than reported waiting times. The authors propose that the wait list time for cardiovascular surgery be redefined as "the time interval between the patient's first contact with a medical care provider with symptoms or signs which ultimately lead to cardiovascular surgery and the date of that surgery".
