CORONARY-ARTERY BYPASS GRAFT-SURGERY IN NEWFOUNDLAND AND LABRADOR

Background: Newfoundland and Labrador, like other health care jurisdic tions, is faced with widening gaps between the demands for health care and a strained ability to supply the necessary resources. The authors carried out a study to determine the rates of appropriate and inappro priate coronary artery bypass grafting (CABG) in the province and the waiting times for this surgery. Methods: This retrospective cohort stu dy was performed in the tertiary care hospital that receives all refer rals for coronary angiography and coronary artery revascularization fo r Newfoundland and Labrador. By reviewing the hospital records, the au thors identified 2 groups of patients: those in whom critical coronary artery disease was diagnosed on the basis of coronary angiography and who were referred for CABG between Apr. 1, 1994, and Mar. 31, 1995, a nd those who actually underwent the procedure during that period. By a pplying specific criteria developed by the RAND Corporation, the autho rs determined the appropriateness and necessity of CABG in each case. They also compared waiting times for CABG with optimal waiting times, as determined by a consensus-based priority score. Results: A total of 338 patients underwent CABG during the study period. The cases were c haracterized by multivessel disease and late-stage angina symptoms. Al most all of the patients had high appropriateness scores (7-9), and ne arly 95% had high necessity scores (7-9). However, during the study pe riod, the waiting list increased by about 20%, because a total of 391 patients were referred by the weekly cardiovascular surgery conference , the authors identified these and an additional 31 patients as having necessity scores of 7 or more. Only 7 (23%) of 31 patients for whom C ABG was considered very urgent underwent surgery within the recommende d 24 hours, and only 30 (24%) of the 122 patients for whom CABG was co nsidered urgent underwent surgery within the recommended 72 hours. Int erpretation: These results provide evidence that the cardiac surgery p rogram in Newfoundland and Labrador is performing CABG in patients for whom surgical revascularization is highly appropriate and necessary. Access to CABG is less than ideal, however, since the waiting list con tinues to expand, and many patients wait beyond the recommended time f or surgery.