An Observational Study to Evaluate 2 Target Times for Elective Coronary Bypass Surgery

Sobolev, Boris; Fradet, Guy; Kuramoto, Lisa; Rogula, Basia

doi:10.1097/mlr.0b013e31824deed2

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…It may also be that at a hospital such as ours where the large majority of patients are minorities and on government based medical coverage, the system is more adept in navigating the challenges of progressing from hospitalization to outpatient referral to elective procedural intervention. It is provocative that in some contexts, there are differences in wait time across race or income, 38,40 but in other scenarios, as in the present study, this is not the case. Whether these differences in socioeconomic disparities are related to bias or an effect of the degree of heterogeneity in patient mix, or something else, is unknown.…”

Section: Discussioncontrasting

confidence: 55%

“…Longer procedural wait times have correlated with worse outcomes and lower patient satisfaction 36,37 . Disparities in procedural wait times along racial lines have been reported 38 . However, we did not observe a significant difference LAAO wait time according to race, with any difference perhaps mitigated by prevalent relative uniformity in health insurance provider in our population, or other system factors related to serving an impoverished community.…”

Section: Discussioncontrasting

confidence: 50%

See 1 more Smart Citation

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Haddad

Bocchese

Garber

et al. 2021

Pacing Clinical Electrophis

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Purpose Non‐white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. Methods We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post‐procedure oral anticoagulation (OAC) use in whites versus non‐whites. Results Among 109 patients undergoing LAAO (45% white), whites had lower CHA2DS2VASc scores, on average, than non‐whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non‐whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non‐whites 5%, p = .33). After adjusting for CHA2DS2VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9‐6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2DS2VASc score and GI bleed severity, whites had a nearly five‐fold odds of being discharged on OAC (OR 4.6, 95% CI [1‐21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [‐.04‐0.11], p = .38). Conclusion Despite an increased prevalence of comorbidities amongst non‐whites, wait time for LAAO and procedural complications were similar in whites versus non‐whites. Among those with prior GI bleed, whites were nearly five‐fold more likely to be discharged on OAC than non‐whites, independent of income.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussioncontrasting

confidence: 50%

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Haddad

Bocchese

Garber

et al. 2021

Pacing Clinical Electrophis

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“…Further investigation of preventative approaches to alleviating ischemic AKI using a moderate intake of anthocyanin‐rich lingonberry juice is warranted, as many surgeries that lead to AKI, such as coronary artery bypass grafting and kidney transplant, can be accompanied by wait times that would allow for pretreatment (up to weeks for coronary artery bypass and up to years for kidney transplant) . This approach may be valuable since it is non‐invasive and only requires a small change in dietary pattern.…”

Section: Discussionmentioning

confidence: 99%

Supplementing diet with Manitoba lingonberry juice reduces kidney ischemia‐reperfusion injury

et al. 2017

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“…Sobolev and Fradet (2008) provide a review of the literature for CABG and suggest that long waits may worsen symptoms and clinical outcomes. Waits may also increase the probability of preoperative death (while waiting) and unplanned emergency admission (Rexius et al, 2004;Sobolev et al, 2006Sobolev et al, , 2012Sobolev and Kuramoto, 2010). The main difference of these studies with ours is the focus on the experience of patients while waiting, as opposed to their health once admitted for surgery, which is instead our focus.…”

Section: Literaturementioning

confidence: 99%

Do waiting times affect health outcomes? Evidence from coronary bypass

Moscelli

Siciliani

Tonei

2016

Social Science & Medicine

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Long waiting times for non-emergency services are a feature of several publicly-funded health systems. A key policy concern is that long waiting times may worsen health outcomes: when patients receive treatment, their health condition may have deteriorated and health gains reduced. This study investigates whether patients in need of coronary bypass with longer waiting times are associated with poorer health outcomes in the English National Health Service over 2000-2010. Exploiting information from the Hospital Episode Statistics (HES), we measure health outcomes with in-hospital mortality and 28-day emergency readmission following discharge. Our results, obtained combining hospital fixed effects and instrumental variable methods, find no evidence of waiting times being associated with higher in-hospital mortality and weak association between waiting times and emergency readmission following a surgery. The results inform the debate on the relative merits of different types of rationing in healthcare systems. They are to some extent supportive of waiting times as an acceptable rationing mechanism, although further research is required to explore whether long waiting times affect other aspects of individuals' life.

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An Observational Study to Evaluate 2 Target Times for Elective Coronary Bypass Surgery

Cited by 13 publications

References 30 publications

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Supplementing diet with Manitoba lingonberry juice reduces kidney ischemia‐reperfusion injury

Do waiting times affect health outcomes? Evidence from coronary bypass

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