This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ray, A. A. Articles by Hirsch, G. M. Search for Related Content PubMed PubMed Citation Articles by Ray, A. A. Articles by Hirsch, G. M. Pubmed/NCBI databases Medline Plus Health Information Heart Surgery Related Collections Health policy and outcome research CV surgery: coronary artery disease CV surgery: valvular disease

(Circulation. 2001;104:I-92.)
© 2001 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Waiting for Cardiac Surgery

Results of a Risk-Stratified Queuing Process

A. Andrew Ray, MSc; Karen J. Buth, MSc; John A. Sullivan, MD, FRCSC; David E. Johnstone, MD, FRCPC; Gregory M. Hirsch, MD, FRCSC

From the Division of Cardiac Surgery (A.A.R., K.J.B., J.A.S., G.M.H.), Queen Elizabeth II Health Sciences Centre, and the Division of Cardiology (D.E.J.), Faculty of Medicine Dalhousie University, Halifax, Nova Scotia, Canada.

Correspondence to Dr Gregory M. Hirsch, Division of Cardiac Surgery, QEII Health Sciences Centre, 1796 Summer St, Suite 2269, Halifax, NS, B3H 3A7, Canada. E-mail ghirsch{at}is.dal.ca

Background— The Queen Elizabeth II Health Sciences Centre uses a weekly peer-review conference of cardiovascular experts to prioritize each surgical case to 1 of 4 queues with the use of standardized criteria of coronary anatomy, stress test result, and symptoms. We examined the hazard of waiting as well as the impact of waiting on surgical outcomes.

Methods and Results— Analysis was performed for 2102 consecutive patients queued for CABG, aortic valve replacement, or CABG+aortic valve replacement between January 1, 1998, and December 31, 1999. Among 1854 patients undergoing surgery, median waiting times on the respective queues were as follows: in-house urgent group, 8 days; semiurgent A group, 37 days; semiurgent B group, 64 days; and elective group, 113 days. There were 13 deaths (12 cardiac) that occurred during the waiting period (0.7% of the patients). Of the 8.7% patients upgraded to a more urgent queue, 86.1% required hospitalization before surgery. Although female sex was not associated with prolonged waiting time, it was predictive of urgent status (P=0.001). The incidence of postoperative complications was 25.0%, and operative mortality was 2.86%. Both were more frequent among patients undergoing surgery early (P=0.01); however, this difference was attributable to the in-house urgent queue. The median length of stay was 7 days for all patients and was not affected by waiting time.

Conclusions— Death and upgrades while the patients were waiting tended to occur early in the queuing process, and prolonged waiting was not associated with worse surgical outcomes. The cost of reducing waiting times could in part be offset by prevention of hospital admissions among upgraded patients.

Key Words: mortality • morbidity • coronary disease • bypass • waiting lists