Analysis of deaths while waiting for cardiac surgery among 29 293 consecutive patients in Ontario, Canada
Objectives To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG. Design Prospective cohort analysis based on an inclusive registry. Setting Nine ca...
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Published in | Heart (British Cardiac Society) Vol. 79; no. 4; pp. 345 - 349 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
London
BMJ Publishing Group Ltd and British Cardiovascular Society
01.04.1998
BMJ BMJ Publishing Group LTD |
Subjects | |
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Abstract | Objectives To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG. Design Prospective cohort analysis based on an inclusive registry. Setting Nine cardiac surgical units in Ontario, Canada. Patients 29 293 consecutive patients scheduled for cardiac surgery between October 1991 and June 1995. Main outcome measures Death rates while waiting for surgery were determined among patients scheduled for isolated CABG, isolated valve surgery, or combined procedures. Predictors of death among patients with isolated CABG were determined from multivariate analysis. Results There were 141 deaths (0.48%) among 29 293 patients. Adjusting for age, sex, and waiting time, patients waiting for valve surgery had a significantly increased risk of death compared with patients waiting for CABG alone (adjusted odds ratio 1.88, 95% confidence interval (CI) 1.23 to 2.88, p = 0.004). Results were similar for patients waiting for combined valve and CABG procedures compared with those who were waiting for isolated CABG. Independent risk factors for death while waiting for isolated CABG included: impaired left ventricular function (odds ratio 2.47, 95% CI 1.59 to 3.84, p < 0.001); advancing age (for each decade, odds ratio 1.41, 95% CI 1.10 to 1.80, p = 0.007); male sex (odds ratio 1.95, 95% CI 1.00 to 3.81, p = 0.05); and waiting longer than the maximum time recommended in Canadian guidelines for a patient’s clinical profile (odds ratio 1.59, 95% CI 1.01 to 2.51, p = 0.044). After scaling waiting time to surgery or death continuously in days, the same predictors emerged. Conclusions Patients waiting for valve surgery have a higher risk of death than patients waiting for isolated CABG. Guidelines to promote safer and fairer queuing for non-CABG cardiac surgery are needed. Shorter waiting lists, better compliance with existing guidelines, and guideline revisions to upgrade patients with left ventricular dysfunction could generate additional reductions in the already low risk of death for patients waiting for isolated CABG. |
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AbstractList | Objectives
—To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG.
Design
—Prospective cohort analysis based on an inclusive registry.
Setting
—Nine cardiac surgical units in Ontario, Canada.
Patients
—29 293 consecutive patients scheduled for cardiac surgery between October 1991 and June 1995.
Main outcome measures
—Death rates while waiting for surgery were determined among patients scheduled for isolated CABG, isolated valve surgery, or combined procedures. Predictors of death among patients with isolated CABG were determined from multivariate analysis.
Results
—There were 141 deaths (0.48%) among 29 293 patients. Adjusting for age, sex, and waiting time, patients waiting for valve surgery had a significantly increased risk of death compared with patients waiting for CABG alone (adjusted odds ratio 1.88, 95% confidence interval (CI) 1.23 to 2.88, p = 0.004). Results were similar for patients waiting for combined valve and CABG procedures compared with those who were waiting for isolated CABG. Independent risk factors for death while waiting for isolated CABG included: impaired left ventricular function (odds ratio 2.47, 95% CI 1.59
to 3.84, p < 0.001); advancing age (for each decade, odds ratio 1.41, 95% CI 1.10 to 1.80, p = 0.007); male sex (odds ratio 1.95,
95% CI 1.00 to 3.81, p = 0.05); and waiting longer than the maximum time recommended in Canadian guidelines for a patient's clinical profile (odds ratio 1.59, 95% CI 1.01 to 2.51, p = 0.044). After scaling waiting time to surgery or death continuously in days, the same predictors emerged.
Conclusions
—Patients waiting for valve surgery have a higher risk of death than patients waiting for isolated CABG. Guidelines to promote safer and fairer queuing for non-CABG cardiac surgery are needed. Shorter waiting lists, better compliance with existing guidelines, and guideline revisions to upgrade patients with left ventricular dysfunction could generate additional reductions in the already low risk of death for patients waiting for isolated CABG.
Keywords: cardiac surgery; waiting lists; rationing Objectives To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG. Design Prospective cohort analysis based on an inclusive registry. Setting Nine cardiac surgical units in Ontario, Canada. Patients 29 293 consecutive patients scheduled for cardiac surgery between October 1991 and June 1995. Main outcome measures Death rates while waiting for surgery were determined among patients scheduled for isolated CABG, isolated valve surgery, or combined procedures. Predictors of death among patients with isolated CABG were determined from multivariate analysis. Results There were 141 deaths (0.48%) among 29 293 patients. Adjusting for age, sex, and waiting time, patients waiting for valve surgery had a significantly increased risk of death compared with patients waiting for CABG alone (adjusted odds ratio 1.88, 95% confidence interval (CI) 1.23 to 2.88, p = 0.004). Results were similar for patients waiting for combined valve and CABG procedures compared with those who were waiting for isolated CABG. Independent risk factors for death while waiting for isolated CABG included: impaired left ventricular function (odds ratio 2.47, 95% CI 1.59 to 3.84, p < 0.001); advancing age (for each decade, odds ratio 1.41, 95% CI 1.10 to 1.80, p = 0.007); male sex (odds ratio 1.95, 95% CI 1.00 to 3.81, p = 0.05); and waiting longer than the maximum time recommended in Canadian guidelines for a patient’s clinical profile (odds ratio 1.59, 95% CI 1.01 to 2.51, p = 0.044). After scaling waiting time to surgery or death continuously in days, the same predictors emerged. Conclusions Patients waiting for valve surgery have a higher risk of death than patients waiting for isolated CABG. Guidelines to promote safer and fairer queuing for non-CABG cardiac surgery are needed. Shorter waiting lists, better compliance with existing guidelines, and guideline revisions to upgrade patients with left ventricular dysfunction could generate additional reductions in the already low risk of death for patients waiting for isolated CABG. Objectives To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG. Design Prospective cohort analysis based on an inclusive registry. Setting Nine cardiac surgical units in Ontario, Canada. Patients 29â[euro][per thousand]293 consecutive patients scheduled for cardiac surgery between October 1991 and June 1995. Main outcome measures Death rates while waiting for surgery were determined among patients scheduled for isolated CABG, isolated valve surgery, or combined procedures. Predictors of death among patients with isolated CABG were determined from multivariate analysis. Results There were 141 deaths (0.48%) among 29â[euro][per thousand]293 patients. Adjusting for age, sex, and waiting time, patients waiting for valve surgery had a significantly increased risk of death compared with patients waiting for CABG alone (adjusted odds ratio 1.88, 95% confidence interval (CI) 1.23 to 2.88, pâ[euro][per thousand]=â[euro][per thousand]0.004). Results were similar for patients waiting for combined valve and CABG procedures compared with those who were waiting for isolated CABG. Independent risk factors for death while waiting for isolated CABG included: impaired left ventricular function (odds ratio 2.47, 95% CI 1.59 to 3.84, pâ[euro][per thousand]<â[euro][per thousand]0.001); advancing age (for each decade, odds ratio 1.41, 95% CI 1.10 to 1.80, pâ[euro][per thousand]=â[euro][per thousand]0.007); male sex (odds ratio 1.95, 95% CI 1.00 to 3.81, pâ[euro][per thousand]=â[euro][per thousand]0.05); and waiting longer than the maximum time recommended in Canadian guidelines for a patient's clinical profile (odds ratio 1.59, 95% CI 1.01 to 2.51, pâ[euro][per thousand]=â[euro][per thousand]0.044). After scaling waiting time to surgery or death continuously in days, the same predictors emerged. Conclusions Patients waiting for valve surgery have a higher risk of death than patients waiting for isolated CABG. Guidelines to promote safer and fairer queuing for non-CABG cardiac surgery are needed. Shorter waiting lists, better compliance with existing guidelines, and guideline revisions to upgrade patients with left ventricular dysfunction could generate additional reductions in the already low risk of death for patients waiting for isolated CABG. |
Author | Sykora, K Morgan, C D Naylor, C D |
AuthorAffiliation | Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada |
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References | Naylor, Morgan, Levinton 1993; 149 Bernstein, Rigter, Brorsson 1997; 42 Naylor 1991; 10 Yusuf, Zucker, Peduzzi 1994; 344 Naylor, Sykora, Jaglal 1995; 346 Suttorp, Kingma, Vos 1992; 13 Naylor, Levinton, Baigrie 1992; 7 Naylor, Chen 1994; 24 Lee, Woodlief, Topol 1995; 91 Rachlis, Olak, Naylor 1991; 1 Naylor, Baigrie, Goldman 1990; 335 Bengtson, Karlsson, Hjalmarson 1997; 17 Maggioni, Maseri, Fresco 1993; 329 Naylor, Slaughter 1994; 3 |
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SubjectTerms | Angina pectoris Biological and medical sciences cardiac surgery Cardiovascular disease Coronary vessels Diabetes Heart surgery Medical sciences Mortality Patients rationing Regression analysis Risk factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Variables Vein & artery diseases waiting lists |
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Title | Analysis of deaths while waiting for cardiac surgery among 29 293 consecutive patients in Ontario, Canada |
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