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Open Access Highly Accessed Research article

The occurrence of adverse events in relation to time after registration for coronary artery bypass surgery: a population-based observational study

Boris G Sobolev1*, Guy Fradet2, Lisa Kuramoto3 and Basia Rogula3

Author Affiliations

1 The University of British Columbia, 828 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada

2 The University of British Columbia, 2251 Pandosy Street, Kelowna, BC V1Y 1T1, Canada

3 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Avenue, Vancouver, Canada

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Journal of Cardiothoracic Surgery 2013, 8:74  doi:10.1186/1749-8090-8-74

Published: 11 April 2013

Abstract

Background

Our objective was to evaluate the effect of delays on adverse events while waiting for coronary artery bypass grafting (CABG).

Methods

An observational study that prospectively followed patients from registration on a wait list to removal for planned surgery, death while waiting, or unplanned emergency surgery. The population-based registry provided data on 12,030 patients with a record of registration on a wait list for first-time isolated CABG surgery between 1992 and 2005.

Results

In total, 104 patients died and 382 patients underwent an emergency surgery before planned CABG. The death rate was 0.5 per 1000 patient-weeks in the semiurgent group and 0.6 per 1000 patient-weeks the nonurgent group, adjusted OR = 1.07 (95% confidence interval [CI] 0.69—1.65). The emergency surgery rate of 1.2 per 1000 patient-weeks in the nonurgent group was lower compared to 2.1 per 1000 patient-weeks in the semiurgent group (adjusted OR = 0.72, 95% CI 0.54–0.97). However, the nonurgent group had a greater cumulative incidence of preoperative death than the semiurgent group for almost all weeks on the wait list, adjusted OR = 1.92 (95% CI 1.25–2.95). The surgery rate was 1.2 per 1000 patient-weeks in the nonurgent group and 2.1 per 1000 patient-weeks in the semiurgent group, adjusted OR = 0.72 (95% CI 0.54–0.97). The cumulative incidence of emergency surgery before planned CABG was similar in the semiurgent and nonurgent groups, adjusted OR = 0.88, (95% CI 0.64–1.20).

Conclusion

Despite similar death rates in the semiurgent and nonurgent groups, the longer waiting times in the nonurgent group result in a greater cumulative incidence of death on the wait list compared to that in the semiurgent group. These longer waiting times also offset the lower rate of emergency surgery before planned admission in the nonurgent group so that the cumulative incidence of the emergency surgery was similar in both groups.

Keywords:
Coronary artery bypass surgery; Hospital wait list; Prioritization; Preoperative death; Emergency surgery