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Published on: March 27, 2018
Patient preference for coronary artery bypass graft surgery performed on the arrested or beating heart: a
Nishith N Patel1, Enoch Akowuah, Jonathan A Hutter
1Bristol Heart Institute, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HN, UK.
Insights
Most patients undergoing coronary artery bypass graft (CABG) surgery prefer surgeons to choose between the
Area of Science:
- Cardiovascular Surgery
- Patient-Centered Care
- Health Policy
Background:
- Patient choice is increasingly emphasized in National Health Service healthcare policy.
- Coronary artery bypass graft (CABG) surgery can be performed using either the 'beating heart' or 'arrested heart' technique.
- Understanding patient preferences regarding surgical technique choice is crucial for informed healthcare policy.
Purpose of the Study:
- To investigate whether patients undergoing CABG surgery wish to choose between the 'beating heart' and 'arrested heart' techniques.
- To assess patient desire for involvement in selecting their surgeon based on preferred surgical technique.
Main Methods:
- A cross-sectional survey using self-reported questionnaires was administered to patients scheduled for elective CABG surgery.
- The questionnaire assessed patient awareness of surgical techniques, preferences, desire for choice, and demographic information.
- Data were collected from 88 patients (73% response rate) between October 2008 and July 2009.
Main Results:
- Only 40% of respondents were aware of the 'beating heart' and 'arrested heart' techniques prior to the survey.
- After receiving information, a significant majority (81%) did not want to choose the surgical technique for their CABG surgery.
- All respondents preferred to defer the decision on the operative technique to the surgeon; demographic factors did not predict patient preference for choice.
Conclusions:
- Cardiac surgical patients generally prefer surgeons to decide the operative technique for coronary artery procedures.
- Patients do not typically desire the option to choose their surgeon based on the surgeon's preferred technique.
- The study suggests that patient involvement in determining operative technique is not universally desired in CABG surgery.
Objective:
Patient choice is now a major facet of health-care policy within the National Health Service. Our objective was to determine whether the patient would like to choose if the 'beating heart' technique or the 'arrested heart' technique is employed for their coronary artery bypass graft (CABG) surgery.
Methods:
We undertook a cross-sectional, self-reported questionnaire survey of patients referred to a regional cardiac surgical unit for elective coronary artery surgery between October 2008 and July 2009. The questionnaire was split into five sections as follows: (1) the patients' awareness of 'beating heart' and 'arrested heart' techniques for CABG surgery, (2) an information sheet detailing both techniques, (3) patients' preference of technique to be used for CABG surgery, (4) whether the patient would like to choose their surgeon according to the surgeons' preferred technique and (5) demographics, including age, sex, and educational qualifications. Data are expressed as counts (percentages).
Results:
The questionnaire was sent to 120 people; 88 returned a completed questionnaire, representing a response rate of 73%. Awareness of 'beating heart' and 'arrested heart' techniques for CABG surgery was reported by 35 respondents (40%). Of these, 74% respondents had no preference of technique used for CABG surgery. After reading the information sheet, 78 (89%) respondents reported no preference of technique used for CABG surgery. As many as 71 (81%) respondents reported that they did not want to be given an opportunity to choose the technique used for CABG surgery, and all respondents preferred to let the surgeon decide the appropriate technique. A binary logistic regression analysis showed that gender, age and level of education were not significant predictors of whether patients wanted to choose the technique to be used for their CABG surgery.
Conclusion:
Cardiac surgical patients prefer to allow the surgeon to determine the technique to be used for their coronary artery operation and do not want to be offered the chance to choose their surgeon according to the surgeons' preferred technique. Involvement of the patient in determining the operative technique is not always desired.
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