Delaying Heart Bypass Surgery Could Be Deadly

Delaying elective coronary artery bypass graft (CABG) surgery may be a significant risk factor for post-operative death, according to a new study.

Researchers at the University of British Columbia (Vancouver, BC, Canada) used a population-based registry to identify patients with established coronary artery disease (CAD) who underwent isolated CABG in British Columbia (Canada). They then studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time - 6 weeks for patients needing semi-urgent surgery, and 12 weeks for those needing non-urgent surgery.

The results showed that among the 7,316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1% (27 deaths among 2,675 patients) for patients treated within the recommended time and 1.5% (70 deaths among 4,641 patients) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely to experience in-hospital death as those for whom CABG was delayed. There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery. The study was published in the September 19, 2008, issue of BMC Health Services Research, a publication of BioMed Central (BMC).

"Our findings suggest a significant survival benefit from performing surgery within the time deemed acceptable by consultant surgeons,” concluded lead author Boris Sobolev, Ph.D., and colleagues of the department of health care and epidemiology. "Uncovering the relationship between timing of surgery and the risk of post-operative death is important in deciding how much capacity is required in the health system to avoid the kind of unacceptable delays that we now know will place patients at risk.”

In order to contain costs, many health care systems use waiting lists; cardiologists decide on the level of urgency of CABG using a common algorithm based on the severity of the patient's condition and the expected benefit of surgery.

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University of British Columbia