Chances of late surgery in relation to length of wait lists

Abstract

BackgroundThe proportion of patients who undergo surgery within a clinically safe time is an important performance indicator in health systems that use wait lists to manage access to care. However, little is known about chances of on-time surgery according to variations in existing demand. We sought to determine what proportion of patients have had late coronary bypass surgery after registration on wait lists of different size in a network of hospitals with uniform standards for timing of surgery.MethodsUsing records from a population-based registry, we studied wait-list times prospectively collected in a cohort of patients registered on wait lists for coronary artery bypass grafting procedures. We compared the number of weeks from registration to surgery against target access times established for three urgency groups. The chances of undergoing surgery within target time have been evaluated in relation to wait-list size at registration and the number of surgeries performed without registration on a wait list.ResultsIn 1991–2001, two in three patients were at risk of late surgery when registered on wait lists for isolated coronary bypass procedures in British Columbia, Canada. Although urgent patients had never seen a wait list with clearance time exceeding one week, the odds of on-time surgery were reduced by 25%, odds ratio [OR] = 0.75 (95% confidence interval [CI] 0.65–0.87) for every additional operation performed without registration on a list. When the wait list at registration required a clearance time of over one month, semi-urgent patients had 51% lower odds of on-time surgery as compared to lists with clearance time less than one week, OR = 0.49 (95%CI 0.41–0.60), after adjustment for age, sex, comorbidity, calendar period, hospital and week on the list. In the non-urgent group, the odds were 69% lower, OR = 0.31 (95%CI 0.20–0.47). Every time an operation in the same hospital was performed without registration on a wait list, the odds of on-time surgery for listed patients were reduced by 7%, OR = 0.93 (95%CI 0.91–0.95) in the semi-urgent group, and by 10%, OR = 0.90 (95%CI 0.87–0.94), in the non-urgent group.ConclusionChances of late surgery increase with the wait-list size for semi-urgent and non-urgent patients needing coronary bypass surgery. The weekly number of patients who move immediately from angiography to the operation without registration on a wait list reduced chances of surgery within target time in all urgency groups of listed patients. When advising patients who will be placed on the wait list about the expected time to treatment, hospital managers should take into account the current list size as well as the weekly number of patients who require CABG immediately after undergoing coronary angiography.

Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

“…However, admission for elective (i.e., non-emergency but necessary) surgery within the recommended time can be easily affected if surgical services experience an uneven influx of more urgent cases [ 9 ]. We previously performed an empirical analysis of a population-based registry and found that the length of the queue at the time of a patient's registration also affected the time to surgery [ 10 ], the probability of surgery being delayed [ 11 ], and the probability of death before planned surgery [ 12 ].…”

Waiting lists: waiting for the evidence!

“…13 For instance, waiting more than 6 months for a hip replacement has a significant impact on physical disability and psychosocial functioning. 14 Although the risk of surgery being overdue increases with longer waiting lists, 15 long waiting times are not necessarily clinically unsafe. Thus, waiting lists should always report the proportion of patients who undergo surgery outside of clinically safe and acceptable time limits because this would allow cases to be redistributed across hospitals to reduce the proportion of late surgeries.…”