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Life and death on the waiting list for coronary bypass surgery
M Doogue1, C Brett, J M Elliott
1Department of Medicine, Christchurch School of Medicine.
Insights
New Zealand patients face significantly longer waiting times for coronary bypass surgery (CABG) compared to Canada. Current priority scoring systems do not predict hospital readmissions during these extended waits.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
Background:
- Coronary bypass surgery (CABG) referral and waiting times vary globally.
- Assessing patient characteristics and clinical events during waiting periods is crucial for healthcare management.
Purpose of the Study:
- To evaluate baseline characteristics of patients referred for isolated CABG.
- To determine waiting times for CABG and associated clinical events.
- To compare New Zealand's priority scoring system with Canada's Ontario urgency score.
Main Methods:
- A consecutive case series of 88 patients referred for CABG in Christchurch, New Zealand, was analyzed.
- Patient outcomes were compared with historical Christchurch and contemporary Canadian data.
- Patients were stratified using both New Zealand and Ontario priority scoring systems.
Main Results:
- Median waiting time for CABG was 92 days, significantly longer than in Canada.
- 25% of patients had left main disease, and 64% experienced angina at rest or on minimal exertion.
- While waiting, 1 patient died, 1 had a myocardial infarction, and 17 were readmitted with unstable angina; priority scores did not predict readmissions.
Conclusions:
- Referral thresholds for CABG are similar between New Zealand and Canada, but waiting times are substantially longer in New Zealand.
- Extended waiting times for CABG impose significant costs on patients and the healthcare system.
- Priority scoring systems aid international comparisons but do not reliably predict adverse events during prolonged waiting periods.
Aim:
To assess the baseline characteristics of patients referred for isolated coronary bypass surgery (CABG), waiting times for coronary bypass surgery and clinical events while waiting for coronary bypass surgery. To compare the New Zealand priority scoring system with a previously validated Ontario urgency score.
Methods:
Outcomes in a consecutive case series of 88 patients referred from Christchurch Hospital for coronary bypass surgery between July 1 and December 31 1993 were compared with a previous Christchurch case series and a contemporary Canadian case series. Patients were stratified according to both Ontario and New Zealand priority scores.
Results:
Of 88 patients, one patient died prior to surgery, 79 had undergone coronary bypass surgery (with three deaths), and eight were still waiting as at December 31 1995. Twenty five percent of patients had left main disease, another 60% had multivessel disease that included the proximal left anterior descending coronary artery and 64% had angina at rest or on minimal exertion. The median waiting time was 92 days (inter-quartile range 20-234), 8 (6-12) days in the 23 patients who underwent surgery as in-hospital cases, and 181 (83-295) in those who waited at home. Patients with left main disease waited a median of 41 (11-205) days. While waiting at home one patient died, one patient suffered a myocardial infarction, and 17 patients were readmitted with unstable angina. Readmissions were not predicted by New Zealand or Ontario priority scores, nor by clinical variables.
Conclusions:
Thresholds for referral are very similar, but waiting times for coronary bypass surgery are far longer in New Zealand than Canada. The long waiting times are a considerable cost to both patients and government. Priority scores facilitate comparison between countries but they may not predict readmission to hospital while on a long waiting list.