Benchmarking the vital risk of waiting for coronary artery bypass surgery in Ontario

Background: Deaths among patients awaiting coronary artery bypass grafting (CABG) are a source of private grief and public concern in Canada. However, some deaths are expected over time among patients with coronary artery dis ease. Methods of benchmarking the burden of delayed care maybe useful in un derstanding and managing waiting lists for CABG and other health: services, The authors therefore determined the vital risk among people waiting for C ABG in Ontario and compared it with the risk in the general population and among people living with coronary artery disease. Methods: Patients registered to undergo CABG in Ontario between 1991 and 19 95 were followed to ascertain numbers and dates of preoperative deaths or c ompleted operations. Linking hospital discharge abstract data to vital stat istics for 1991 to 1994, the authors defined a cohort of people who had sur vived 6 months after an acute myocardial infarction (AMI) and followed them for an additional 6 months to determine numbers and dates of deaths. They matched patients by age and sex and then calculated the standardized mortal ity ratio for each cohort (i.e., the ratio of observed deaths to those expe cted based on age and sex-specific daily probabilities of death for the pro vincial population). Results: Among 21 220 patients awaiting CABG, there were 82 preoperative de aths over a median follow-up of 18 days; the standardized mortality ratio w as 2.92 (95% confidence limit [CL] 2.29-3.55). Among 21 220 matched 6-month survivors of an AMI, there were 663 deaths over a median follow up of 185 days; the standardized mortality ratio was 3.84 (95% CI 3.54-4.14). Interpretation: Patients awaiting CABG in Ontario are at a much greater ris k of death than the general population. However, when compared with thousan ds of other patients living with coronary artery disease, they are at simil ar or decreased vital risk.