PMID- 7500756
OWN - NLM
STAT- MEDLINE
DCOM- 19960118
LR  - 20190611
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 346
IP  - 8990
DP  - 1995 Dec 16
TI  - Waiting for coronary artery bypass surgery: population-based study of 8517 
      consecutive patients in Ontario, Canada. The Steering Committee of the Adult 
      Cardiac Care Network of Ontario.
PG  - 1605-9
AB  - Deaths and delays in queues for coronary surgery in Canada have been highlighted 
      by American interest groups opposed to "socialized medicine". Since 1991 all nine 
      cardiac surgery centres in Ontario register and follow patients after acceptance 
      for surgery. We examined the experience of 8517 consecutive patients leaving the 
      registry from October 1991 to July 1993. Individual acuity scores were determined 
      based on symptoms, angiographic findings, left ventricular function, and, where 
      available, non-invasive tests of ischaemic jeopardy. Planned surgery was declined 
      or deferred for 3.2% of registrants. While in the queue, 31 (0.4%) patients died 
      and three had surgery indefinitely deferred after a non-fatal myocardial 
      infarction. Among 8213 patients receiving surgery, the median wait was 17 days 
      (inter-quartile range [IQR]: 4, 51), ranging from one day (IQR 0:4) for patients 
      needing very urgent surgery (acuity score 2-3) to 42 days (IQR: 18, 77) for those 
      rated low priority (acuity score 6-7). In a multivariate analysis, the most 
      important determinant of waiting time was symptom status (p < 0.001), followed by 
      anatomy (p < 0.001). Age did not alter waiting time; depending on statistical 
      methods, female sex was either not significant or independently associated with 
      approximately 11% relative delay (p = 0.001). Whether controlling for significant 
      clinical factors or the multifactorial acuity scores, waiting times clearly 
      varied (p < 0.001) among hospitals. We conclude that, during 1991-93, patients 
      queuing for coronary surgery in Ontario rarely suffered critical events or 
      extreme delays, and individual variation in waiting times primarily reflected 
      clinical acuity. Nonetheless, symptoms provoked by very modest exertion were 
      commonplace in the queue, and waiting times did vary inequitably among hospitals.
FAU - Naylor, C D
AU  - Naylor CD
AD  - Institute for Clinical Evaluative Sciences in Ontario, Canada.
FAU - Sykora, K
AU  - Sykora K
FAU - Jaglal, S B
AU  - Jaglal SB
FAU - Jefferson, S
AU  - Jefferson S
LA  - eng
PT  - Journal Article
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
SB  - IM
CIN - Lancet. 1995 Dec 16;346(8990):1570-1. PMID: 7500744
CIN - Lancet. 1996 Feb 24;347(9000):540-41. PMID: 8596285
MH  - Aged
MH  - *Coronary Artery Bypass
MH  - Coronary Disease/diagnosis
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ontario
MH  - Patient Selection
MH  - Referral and Consultation
MH  - Time Factors
MH  - *Waiting Lists
EDAT- 1995/12/16 00:00
MHDA- 1995/12/16 00:01
CRDT- 1995/12/16 00:00
PHST- 1995/12/16 00:00 [pubmed]
PHST- 1995/12/16 00:01 [medline]
PHST- 1995/12/16 00:00 [entrez]
AID - S0140-6736(95)91934-1 [pii]
AID - 10.1016/s0140-6736(95)91934-1 [doi]
PST - ppublish
SO  - Lancet. 1995 Dec 16;346(8990):1605-9. doi: 10.1016/s0140-6736(95)91934-1.