Heart bypass surgery: deadly delays

Delaying elective coronary artery bypass graft (CABG) surgery may be a significant risk factor for post-operative death. Research published today in the open access journal BMC Health Services Research reveals that when patients received timely surgery, the risk of death was reduced by a third.

In British Columbia, Canada, recommended maximum waiting times for CABG surgery are six weeks for semi-urgent cases and twelve weeks for cases that are non-urgent. Heart surgeons decide on the level of urgency using a common algorithm based on the severity of the patient's condition and the expected benefit of surgery. Boris Sobolev, Canada Research Chair from The University of British Columbia, led a team of researchers at the Vancouver Coastal Health Research Institute that investigated the outcome of heart bypass surgery among patients who were either treated on time or made to wait. He said, "Our findings suggest a significant survival benefit from performing surgery within the time deemed acceptable by consultant surgeons".

In order to contain costs, many health care systems use waiting lists. Establishing a time that patients can safely wait for their operations is generally perceived to be a suitable method for preventing adverse outcomes. Surprisingly, however, until now there have been no direct estimates of the benefits gained from performing CABG surgery in a timely manner. According to the authors, "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".

During the study period, of the 7316 patients who underwent CABG on a semi-urgent and non-urgent basis, 97 died in hospital. There were 27 deaths among the 2675 patients who had early surgery and 70 deaths among the 4641 patients who had late surgery.

1. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality
Boris G Sobolev, Guy Fradet, Robert Hayden, Lisa Kuramoto, Adrian R Levy and Mark J FitzGerald
BMC Health Services Research (in press)

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