Variables Associated With Cardiac Surgical Waitlist Mortality From a Population-Based Cohort.

Area of Science:

• Cardiology
• Surgical Triage
• Health Outcomes Research

Background:

• Cardiac surgery waitlist recommendations, based on expert opinion, demonstrate poor predictive accuracy for preoperative mortality.
• Existing studies on risk factors for waitlist mortality have not assessed the impact of nonadherence to established benchmarks.

Purpose of the Study:

• To identify independent predictors of waitlist mortality in patients undergoing cardiac surgery.
• To compare the predictive performance of identified variables against current Canadian Cardiovascular Society (CCS) waitlist recommendations.

Main Methods:

• A Fine and Gray competing risk model was employed to analyze data from 12,106 patients between 2005 and 2015.
• Predictive variables were assessed for their ability to predict waitlist mortality in urgent, semi-urgent, and non-urgent surgical cases.
• The Akaike information criterion was used to compare the predictive power of identified variables against CCS guidelines.

Main Results:

• 101 patients (0.8%) died while awaiting cardiac surgery, with waitlist deaths concentrated in emergent and urgent categories.
• Adherence to CCS waitlist recommendations was higher in patients who died awaiting surgery and did not predict mortality.
• Independent predictors of waitlist mortality included age, aortic surgery, low ejection fraction, urgent surgery status, prior myocardial infarction, hemodynamic instability, hypertension, and dyslipidemia.

Conclusions:

• Canadian Cardiovascular Society waitlist recommendations exhibit poor predictive value for cardiac surgery waitlist mortality.
• Identified evidence-based predictors demonstrate superior clinical performance compared to current CCS guidelines.
• Re-evaluation of cardiac surgical triage criteria using robust, evidence-based data is warranted to improve patient outcomes.