Assessing the risk of waiting for coronary artery bypass graft surgery among patients with stenosis of the left main coronary artery

Légaré, Jean‐François

doi:10.1503/cmaj.050053

Cited by 24 publications

(14 citation statements)

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“…No significant differences were noted between geographical regions. The reduction in overall wait for patients presenting to the ER was a result of a reduction in the referral to specialist wait and the specialist to catheterization wait, rather than a shorter surgical wait time, reflecting similar perceived urgency based on previously described objective criteria (3)(4)(5). One should also note that overall, the median wait time from presentation to specialist was longer in the HRM (P<0.01) and wait time from specialist to catheterization was shorter in the HRM than in other regions (P<0.05) ( Figure 3A).…”

Section: Wait Timesmentioning

confidence: 55%

“…Indications for CABG surgery were based on a weekly peer review process involving cardiologists, cardiac surgeons and cardiac radiologists. Individual patients were queued for surgery based on objective criteria as previously described (3,4). Briefly, patients were queued according to standard criteria, with two major determinants (anatomy of coronary disease and symptom severity) and two minor determinants (left ventricular function and results of noninvasive testing).…”

Section: Populationmentioning

confidence: 99%

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How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

Légaré

Buth

2010

Canadian Journal of Cardiology

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W ait times for health care has been a popular topic in recent discussions of health care management and reform. However, the media tends to focus on wait times for surgery and high-technology imaging tests. These late-stage wait times are only a portion of the total wait time leading up to surgery. Thus, current metrics underestimate the total wait time surgical patients experience. For example, Munt et al (1) have found that current methods underestimate the wait time for surgical treatment of aortic stenosis by a factor of 3.2. Knudtson et al (2) have proposed that it is likely that patients face the greatest wait-related risk in the earlier phases of care, before the disease is adequately characterized.Recently, a number of authors have suggested alternate ways of defining wait times to reflect the patient's perspective on waiting for care. For example, Munt et al (1) have proposed that the wait time for cardiovascular surgery be redefined as "the time interval between the patient's first contact with a medical care provider with symptoms or signs which ultimately lead to cardiovascular surgery and the date of that surgery". This would effectually lead to an examination of the total wait time surgical patients experience. These authors propose that a universal wait time definition must meet three criteria: the time interval should be representative of the time the patient is at risk for morbidity and mortality; the time interval should be applicable and reproducible across all jurisdictions; and the time interval should be easily and inexpensively tracked, preferably with pre-existing databases (1,2).The present study represents pilot work designed to examine the feasibility of using administrative databases, specifically Nova Scotia's Medical Services Insurance (MSI) physician billing database, to METHODS:The Maritime Heart Center (Halifax, Nova Scotia) cardiac surgery database was used to identify all consecutive patients who underwent elective coronary artery bypass graft surgery between 2002 and 2005 from a single urgency queue. The provincial physician billing database provided a timeline record of dates, physician visits, and diagnoses or procedures performed for each patient. This information was used to assess total and component wait times leading to cardiac surgery. RESULTS: A total of 705 consecutive patients were included and stratified based on geographical location: urban Halifax Regional Municipality (HRM; n=222), urban non-HRM (n=220) and rural (n=263). Patients from all regions did not differ in age, sex, comorbidities or ventricular function. Using a traditional definition of wait time (time listed), patients waited a median of 56 days (interquartile range [IQR] 38 to 77 days). In comparison, the total wait times based on the time from presentation to surgery were a median of 109 days (IQR 56 to 184 days) for HRM, a median of 121 days (IQR 77 to 184 days) for urban non-HRM and a median of 123 days (IQR 79 to 169 days) for rural patients (P-value nonsignificant). Two modes of presentatio...

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Section: Wait Timesmentioning

confidence: 55%

Section: Populationmentioning

confidence: 99%

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

Légaré

Buth

2010

Canadian Journal of Cardiology

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“…Although percutaneous coronary intervention can be performed for unprotected LMCA stenosis, surgery is still the preferred method of treatment in most centers (Tan et al 2001;Takagi et al 2002). Studies performed to find out the optimal operating time for patients with LMCA disease are limited and have given contraversial results (Maziak et al 1996;Gol et al 2000;Da Rocha and da Silva 2003;Legare et al 2005;Virani et al 2006). Although some studies report that the risk is not increased as preoperative waiting time prolongs, they were not primarily focused on the patients with LMCA stenosis (Morgan et al 1998;Rexius et al 2004).…”

Section: Discussionmentioning

confidence: 99%

“…They suggested that patients with LMCA stenosis of 75% or more, those in New York Heart Association functional class IV heart failure, and those who had experienced a preoperative myocardial infarction should undergo CABG early ( 10 days after coronary angiography). In the study reported by Legare et al (2005), patients were assigned into 4 different groups as preoperative waiting time in which the standart waiting times were 0, 7, 21 and 56 days respectively. They reported that myocardial infarction within 7 days before surgery, preopera-tive renal failure, ejection fraction of less than 40%, age greater than 70 years and stenosis of LMCA greater than 70% were independent predictors of the worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However this recommendation is not supported with well designed studies but is expressed as expert opinion. Studies performed primarily on patients with LMCA disease are scarce, limited in number of patients recruited and have given controversial results (Maziak et al 1996;Gol et al 2000; Da Rocha and da Silva 2003; Legare et al 2005;Virani et al 2006). Therefore, in this study we aimed to assess the effect of waiting time on in-hospital morbidity and mortality in patients with LMCA stenosis and to identify the risk factors associated with adverse cardiovascular events before and during surgery.…”

mentioning

confidence: 99%

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Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

Sarı

Acar

Nurkalem

et al. 2007

Tohoku J. Exp. Med.

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Contoversy exists about the optimal operation time of the patients with left main coronary artery (LMCA) stenosis. We therefore, aimed to investigate the effect of waiting time on in-hospital morbidity and mortality in patients with LMCA stenosis and identify the risk factors associated with adverse cardiovascular events before and during surgery. One hundred seventy six patients with LMCA stenosis were divided into two groups according to the time period between coronary angiography and coronary artery bypass surgery (group 1: 7 days, 94 patients; and group 2: > 7 days, 82 patients). Primary end points were death and major adverse cardiac event (MACE): in-hospital death, sustained ventricular tachycardia or ventricular fibrillation development, postoperative stay in the intensive care > 48 hrs and in hospital > 9 days. Demographic and clinical characteristics of patients in groups 1 and 2 were comparable. There was no difference between the two groups in terms of in-hospital morbidity, mortality and MACE. When we analyzed the differences between the patients with and without MACE, the patients who experienced MACE were older ( p = 0.001), and had higher degree of LMCA stenosis ( p = 0.01), higher degree of right coronary artery stenosis ( p = 0.02), higher blood urea level ( p = 0.003), and higher incidence of unstable angina or myocardial infarction within 2 weeks ( p = 0.001). Independent risk factors for MACE were unstable angina or myocardial infarction within 2 weeks, age more than 70 years and stenosis more than 75% in the LMCA. These results suggest that preoperative clinical status but not waiting time predicts in-hospital surgical outcomes in LMCA stenosis.left main coronary artery stenosis; surgery; waiting time

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The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient‐reported Outcome Dataset

2015

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Reducing waiting times has been a major focus of the English National Health Service for many years, but little is known about the impact on health outcomes. The collection of data on patient-reported outcome measures for all patients undergoing four large-volume procedures facilitates analysis of the impact of waiting times on patient outcomes. The availability of patient-reported outcome measures before and after surgery allows us to estimate the impact of waiting times on the effectiveness of treatment, controlling for pre-surgery health and the endogeneity of waiting times caused by prioritisation with respect to pre-intervention health. We find that waiting time has a negative and statistically significant impact on the health gain from hip and knee replacement surgery and no impact on the effectiveness of varicose vein and hernia surgery. The magnitude of this effect at patient level is small, 0.1% of the outcome measure range for each additional week of waiting. However, the value of this effect is substantially larger than existing estimates of the disutility experienced during the waiting period. The health losses associated with an additional week of waiting for annual populations of hip and knee replacement patients are worth £11.1m and £11.5m, respectively. Copyright © 2015 John Wiley & Sons, Ltd.

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Assessing the risk of waiting for coronary artery bypass graft surgery among patients with stenosis of the left main coronary artery

Cited by 24 publications

References 14 publications

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient‐reported Outcome Dataset

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