WAITING FOR CORONARY-ARTERY BYPASS-SURGERY - POPULATION-BASED STUDY OF 8517 CONSECUTIVE PATIENTS IN ONTARIO, CANADA

Deaths and delays in queues for coronary surgery in Canada have been h ighlighted by American interest groups opposed to ''socialised medicin e''. Since 1991 all nine cardiac surgery centres in Ontario register a nd follow patients after acceptance for surgery. We examined the exper ience of 8517 consecutive patients leaving the registry from October 1 991 to July 1993. Individual acuity scores were determined based on sy mptoms, angiographic findings, left ventricular function, and, where a vailable, non-invasive tests of ischaemic jeopardy. Planned surgery wa s declined or deferred for 3.2% of registrants. While in the queue, 31 (0.4%) patients died and three had surgery indefinitely deferred afte r a nonfatal myocardial infarction. Among 8213 patients receiving surg ery, the median wait was 17 days (inter-quartile range [IQR]: 4, 51), ranging from one day (IQR 0:4) for patients needing very urgent surger y (acuity score 2-3) to 42 days (IQR: 18, 77) for those rated low prio rity (acuity score 6-7). In a multivariate analysis, the most importan t determinant of waiting time was symptom status (p<0.001), followed b y anatomy (p<0.001). Age did not alter waiting time; depending on stat istical methods, female sex was either not significant or independentl y approximately 11% relative delay controlling for significant clinica l factors or the multifactorial acuity scores, waiting times clearly v aried (p<0.001) among hospitals. We conclude that, during 1991-93, pat ients queuing for coronary surgery in Ontario rarely suffered critical events or extreme delays, and individual variation in waiting times p rimarily reflected clinical acuity. Nonetheless, symptoms provoked by very modest exertion were commonplace in the queue, and waiting times did vary inequitably among hospitals.