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Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study

BACKGROUND: In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait li...

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Autores principales: Sobolev, Boris G, Kuramoto, Lisa, Levy, Adrian R, Hayden, Robert
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564012/
https://www.ncbi.nlm.nih.gov/pubmed/16930475
http://dx.doi.org/10.1186/1749-8090-1-21
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author Sobolev, Boris G
Kuramoto, Lisa
Levy, Adrian R
Hayden, Robert
author_facet Sobolev, Boris G
Kuramoto, Lisa
Levy, Adrian R
Hayden, Robert
author_sort Sobolev, Boris G
collection PubMed
description BACKGROUND: In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. METHODS: The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. RESULTS: Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02–2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54–1.04) vs. 0.58 (95% CI 0.42–0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01–2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. CONCLUSION: Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.
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spelling pubmed-15640122006-09-12 Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study Sobolev, Boris G Kuramoto, Lisa Levy, Adrian R Hayden, Robert J Cardiothorac Surg Research Article BACKGROUND: In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. METHODS: The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. RESULTS: Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02–2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54–1.04) vs. 0.58 (95% CI 0.42–0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01–2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. CONCLUSION: Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list. BioMed Central 2006-08-24 /pmc/articles/PMC1564012/ /pubmed/16930475 http://dx.doi.org/10.1186/1749-8090-1-21 Text en Copyright © 2006 Sobolev et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Sobolev, Boris G
Kuramoto, Lisa
Levy, Adrian R
Hayden, Robert
Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
title Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
title_full Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
title_fullStr Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
title_full_unstemmed Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
title_short Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
title_sort cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564012/
https://www.ncbi.nlm.nih.gov/pubmed/16930475
http://dx.doi.org/10.1186/1749-8090-1-21
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