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Coronary artery bypass graft surgery in Newfoundland and Labrador
G A Fox1, J O'Dea, P S Parfrey
1Patient Research Center, General Hospital, Memorial University of Newfoundland, St. John's, Nfld.
Insights
Coronary artery bypass grafting (CABG) in Newfoundland and Labrador is appropriate for most patients, but access is limited. Waiting lists are growing, and many patients experience delays for this crucial heart surgery.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Public Health
Background:
- Healthcare systems face challenges balancing demand and resources.
- Assessing the utilization and timeliness of cardiac procedures is critical.
Purpose of the Study:
- To evaluate the appropriateness of coronary artery bypass grafting (CABG) in Newfoundland and Labrador.
- To determine waiting times for CABG and compare them to optimal standards.
Main Methods:
- Retrospective cohort study of patients referred for CABG in Newfoundland and Labrador.
- Utilized RAND Corporation criteria to assess CABG appropriateness and necessity.
- Compared actual waiting times against consensus-based priority scores.
Main Results:
- 338 patients underwent CABG, predominantly with multivessel disease and late-stage angina.
- High appropriateness (7-9) and necessity (7-9) scores were observed in nearly all cases.
- The CABG waiting list increased by 20%; only 23% of very urgent cases and 24% of urgent cases met recommended waiting times.
Conclusions:
- Cardiac surgery in Newfoundland and Labrador performs CABG appropriately and necessarily.
- Access to CABG is suboptimal due to an expanding waiting list and prolonged wait times.
Background:
Newfoundland and Labrador, like other health care jurisdictions, is faced with widening gaps between the demands for health care and a strained ability to supply the necessary resources. The authors carried out a study to determine the rates of appropriate and inappropriate coronary artery bypass grafting (CABG) in the province and the waiting times for this surgery.
Methods:
This retrospective cohort study was performed in the tertiary care hospital that receives all referrals for coronary angiography and coronary artery revascularization for Newfoundland and Labrador. By reviewing the hospital records, the authors identified 2 groups of patients: those in whom critical coronary artery disease was diagnosed on the basis of coronary angiography and who were referred for CABG between Apr. 1, 1994, and Mar. 31, 1995, and those who actually underwent the procedure during that period. By applying specific criteria developed by the RAND Corporation, the authors determined the appropriateness and necessity of CABG in each case. They also compared waiting times for CABG with optimal waiting times; as determined by a consensus-based priority score.
Results:
A total of 338 patients underwent CABG during the study period. The cases were characterized by multivessel disease and late-stage angina symptoms. Almost all of the patients had high appropriateness scores (7-9), and nearly 95% had high necessity scores (7-9). However, during the study period, the waiting list increased by about 20%, because a total of 391 patients were referred by the weekly cardiovascular surgery conference; the authors identified these and an additional 31 patients as having necessity scores of 7 or more. Only 7 (23%) of 31 patients for whom CABG was considered very urgent underwent surgery within the recommended 24 hours, and only 30 (24%) of the 122 patients for whom CABG was considered urgent underwent surgery within the recommended 72 hours.
Interpretation:
These results provide evidence that the cardiac surgery program in Newfoundland and Labrador is performing CABG in patients for whom surgical revascularization is highly appropriate and necessary. Access to CABG is less than ideal, however, since the waiting list continues to expand, and many patients wait beyond the recommended time for surgery.