MORTALITY AND THE LENGTH OF STAY ON THE W AITING LIST FOR CORONARY-ARTERY BYPASS-SURGERY - THE MUNICH EXPERIENCE

Short-term and long-term results are the classical parameters for qual ity assurance in coronary artery bypass graft surgery (CABGS). In cont rast, waiting times and the inherent risks of waiting lists are usuall y neglected. Although the problem of ''death on the waiting list'' is generally known, related publications are scarce. Therefore, in Januar y 1994, we started a prospective study to document the waiting times a nd the occurrence of severe complications in our patients waiting for CABGS. Between January 1, 1994 and July 31, 1996, we catheterized 1125 patients with indication for CABGS. 968 patients had social health in surance (SOCL); 157 patients were privately insured (PRIV). The urgenc y of CABGS was classified as ''emergent'', ''very urgent'' and ''less urgent'' according to the clinical experience of the responsible cardi ologists. All emergency cases could be operated the same day. 69% of t he very urgent SOCL patients had to travel beyond the Munich area to b e operated, while 84% of the respective PRIV patients were operated in Munich. SOCL patients were therefore separated from their families 4. 3 times more frequently than PRIV. Not so urgent SOCL cases were separ ated from their families 1.8 times more often than PRIV. The mean wait ing time for SOCL was 39.5 +/- 39.1 days in 1994, 34.9 +/- 31.5 days i n 1995 and 22.7 +/- 16 days in 1996. The corresponding values for PRIV are 19.1 +/- 16.2, 19.8 +/- 14.1 and 17.2 +/- 12.6 days. The risk of dying while waiting for CABGS was 1.3% per month (15/1125). The reduct ion of waiting times by the factor of two between 1994 and 1996 did no t, however, influence the death on the waiting list, because all death s occurred within 4 weeks after diagnostic catheterization. Our result s show that triage practices for patients requiring CABGS are not reli able. To minimize the risk of the ''death on the waiting list'', CABGS must be offered within a week after diagnostic coronary angiography, even for ''elective'' cases.