LIFE AND DEATH ON THE WAITING LIST FOR CORONARY-BYPASS SURGERY

Aim. To assess the baseline characteristics of patients referred for i solated coronary bypass surgery (CABG), waiting times for coronary byp ass surgery and clinical events while waiting for coronary bypass surg ery. To compare the New Zealand priority scoring system with a previou sly validated Ontario urgency score. Methods. Outcomes in a consecutiv e case series of 88 patients referred from Christchurch Hospital for c oronary bypass surgery between July 1 and December 31 1993 were compar ed with a previous Christchurch case series and a contemporary Canadia n case series. Patients were stratified according to both Ontario and New Zealand priority scores. Results. Of 88 patients, one patient died prior to surgery, 79 had undergone coronary bypass surgery (with thre e deaths), and eight were still waiting as at December 31 1995. Twenty five percent of patients had left main disease, another 60% had multi vessel disease that included the proximal left anterior descending cor onary artery and 64% had angina at rest or on minimal exertion. The me dian waiting time was 92 days (inter-quartile range 20-234), 8 (6-12) days in the 23 patients who underwent surgery as in-hospital cases, an d 181 (83-295) in those who waited at home. Patients with left main di sease waited a median of 41 (11-205) days. While waiting at home one p atient died, one patient suffered a myocardial infarction, and 17 pati ents were readmitted with unstable angina. Readmissions were not predi cted by New Zealand or Ontario priority scores, nor by clinical variab les. Conclusions. Thresholds for referral are very similar, but waitin g times for coronary bypass surgery are far longer in New Zealand than Canada. The long waiting times are a considerable cost to both patien ts and government. Priority scores facilitate comparison between count ries but they may not predict readmission to hospital while on a long waiting list.