Surgical standby for percutaneous transluminal coronary angioplasty: a survey of patterns of practice
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Published on: September 22, 2020
D E Cameron1, D C Stinson, P S Greene
1Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Surgical standby for percutaneous transluminal coronary angioplasty (PTCA) varies, with open operating rooms most common. Lower volume PTCA centers had higher emergency coronary artery bypass grafting (CABG) rates for complications.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization procedure.
- Surgical standby, typically coronary artery bypass grafting (CABG), is crucial for managing PTCA complications.
- Patterns of surgical backup for PTCA are not well-defined.
Purpose of the Study:
- To investigate current practices and patterns of surgical standby for PTCA in US institutions.
- To determine the incidence of emergency and urgent CABG following PTCA.
- To identify factors influencing surgical backup strategies.
Main Methods:
- A questionnaire was mailed to 196 US institutions performing PTCA and CABG.
- Eighty-nine institutions (46% response rate) provided data on their PTCA volume, CABG rates, and standby procedures.
- Data analysis focused on comparing practices between high- and low-volume PTCA centers.
Main Results:
- The rate of emergency CABG for PTCA complications was 4.4%, with higher rates in low-volume centers (5.1%) compared to high-volume centers (3.7%).
- The most common surgical standby practice was maintaining an open operating room (64%), followed by next available room access (24%).
- Flexible backup arrangements based on PTCA risk were used by 29% of institutions; 38% had routine pre-PTCA evaluations, and 51% charged standby fees.
Conclusions:
- Surgical standby practices for PTCA are diverse, with significant variation in operating room availability and risk assessment.
- Low-volume PTCA centers experience a higher incidence of emergency CABG for complications, highlighting potential disparities in care.
- The study underscores the need for standardized protocols and efficient resource allocation for PTCA-related surgical backup.
Abstract:
To determine patterns of surgical standby for percutaneous transluminal coronary angioplasty (PTCA), a questionnaire was mailed to 196 US institutions in which PTCA and coronary artery bypass grafting (CABG) are performed regularly. Eighty-nine responses (46%) were received and comprise this report. Of responding institutions, the mean number of hospital beds was 615. In 1987, these institutions performed a mean of 337 PTCAs and 558 open-heart surgical procedures. The rate of emergency CABG for PTCA complications (occlusion, dissection, or coronary perforation) was 4.4% +/- 0.3%, whereas the rate of urgent CABG (within 24 hours) for PTCA failure was 3.7 +/- 0.6%. The incidence of emergency CABG for PTCA complications was higher (5.1% +/- 0.6%) among low-volume PTCA centers (less than 250 cases per year) than at high-volume centers (more than 250 cases per year) (3.7% +/- 0.3%; p less than 0.05). The most common pattern of surgical backup was to maintain an open operating room on standby (57/89, 64%), and the second most common pattern was to make the next open operating room available, allowing operating room access within 1 to 3 hours (21/89, 24%). Nearly a third of institutions (26/89, 29%) maintained a flexible backup arrangement according to PTCA risk. Routine pre-PTCA patient evaluation by surgeon and/or anesthesiologist occurred in 38% (34/89). Fees for standby services were charged by 51% of surgical teams (45/89), 39% of anesthesia teams (35/89), and 38% of operating room facilities (34/89).(ABSTRACT TRUNCATED AT 250 WORDS)
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