Waiting for cardiac surgery - Results of a risk-stratified queuing process

Background-The Queen Elizabeth II Health Sciences Centre uses a weekly peer -review conference of cardiovascular experts to prioritize each surgical ca se to 1 of 4 queues with the use of standardized criteria of coronary anato my, stress test result. and symptoms. We examined the hazard of waiting as well as the impact of waiting on surgical outcomes. Methods and Results-Analysis was performed for 2102 consecutive patients qu eued for CABG, aortic valve replacement, or CABG+aortic valve replacement b etween January 1, 1998, and December 31, 1999. Among 1854 patients undergoi ng surgery, median waiting times on the respective queues were as follows: in-house urgent group, 8 days; semiurgent A group, 37 days; semiurgent B gr oup, 64 days; and elective group, 113 days. There were 13 deaths (12 cardia c) that occurred during the waiting period (0.7% of the patients). Of the 8 .7% patients upgraded to a more urgent queue, 86.1% required hospitalizatio n before surgery. Although female sex was not associated with prolonged wai ting time, it was predictive of urgent status (P=0.001). The incidence of p ostoperative complications was 25.0%, and operative mortality was 2.86%. Bo th were more frequent among patients undergoing surgery early (P=0.01); how ever, this difference was attributable to the in-house urgent queue. The me dian length of stay was 7 days for all patients and was not affected by wai ting time. Conclusions-Death and upgrades while the patients were waiting tended to oc cur early in the queuing process, and prolonged waiting was not associated with worse surgical outcomes. The cost of reducing waiting times could in p art be offset by prevention of hospital admissions among upgraded patients.