BMC: Delaying heart bypass surgery can be deadly

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

In British Columbia, Canada, the recommended maximum waiting time for CABG surgery is six weeks for semi-urgent cases and 12 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, the 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 CABG among patients who were either treated on time or made to wait.

During the study period, of the 7,316 patients who underwent CABG on a semi-urgent and non-urgent basis, 97 died in hospital. The investigators found that there were 27 deaths among the 2,675 patients, who had early surgery and 70 deaths among the 4,641 patients who had late surgery.

“Our findings suggest a significant survival benefit from performing surgery within the time deemed acceptable by consultant surgeons,” Sobolev said.

In order to contain costs, many healthcare systems, especially in countries with universal healthcare systems, use waiting lists, the authors noted. 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, the Sobolev and colleagues said that 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.”