Analysis of deaths while waiting for cardiac surgery among 29 293 consecutive patients in Ontario, Canada
Analysis of deaths while waiting for cardiac surgery among 29 293 consecutive patients in Ontario, Canada
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DOI：
10.1136/hrt.79.4.345
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发表时间：
1998-04-01
期刊：
影响因子：
5.7
通讯作者：
Naylor, CD
中科院分区：
文献类型：
--
作者：
Morgan, CD;Sykora, K;Naylor, CD
目的：评估等待心脏瓣膜手术或单纯冠状动脉旁路手术(CABG)的患者的死亡率，并确定在等待单独CABG期间死亡的独立危险因素。设计-基于包容性登记的前瞻性队列分析。设置-加拿大安大略省的9个心脏外科单位。患者-1991年10月至1995年6月期间连续29 293名计划进行心脏手术的患者。主要结果指标--计划进行单独CABG、单独瓣膜手术或联合手术的患者在等待手术期间的死亡率。结果：29293例患者中有141例死亡(0.48%)。调整年龄、性别和等待时间，与仅等待冠状动脉搭桥术的患者相比，等待瓣膜手术的患者的死亡风险显著增加(调整后的优势比1.88，95%可信区间1.23至2.88，p=0.004)。与等待单独冠状动脉搭桥术的患者相比，等待瓣膜和CABG联合手术的患者的结果相似。死亡的独立危险因素包括：左心功能受损(优势比2.47，95%可信区间1.59比3.84，p<；0.001)；年龄增大(每十年优势比1.41，95%可信区间1.10比1.80，p=0.007)；男性(优势比1.95，95%可信区间1.00比3.81，p=0.007)；等待时间超过加拿大临床资料指南中建议的最长时间(优势比1.59，95%可信区间1.01至2.51，p=0.044)。在连续几天将等待时间延长到手术或死亡后，出现了相同的预测因素。结论-等待瓣膜手术的患者比等待单独冠状动脉搭桥术的患者死亡风险更高。需要指南来促进非CABG心脏手术更安全、更公平的排队。更短的等待名单，更好地遵守现有指南，以及修订指南以升级左心功能不全患者，可能会进一步降低等待单独冠状动脉搭桥术的患者本已很低的死亡风险。
Objectives-To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG.Design-Prospective cohort analysis based on an inclusive registry.Setting-Nine cardiac surgical units in Ontario, Canada.Patients-29 293 consecutive patients scheduled for cardiac surgery between October 1991 and June 1995.Main outcome measures-Death rates while waiting for surgery were determined among patients scheduled for isolated CABG, isolated valve surgery, or combined procedures. Predictors of death among patients with isolated CABG were determined from multivariate analysis.Results-There were 141 deaths (0.48%) among 29 293 patients. Adjusting for age, sex, and waiting time, patients waiting for valve surgery had a significantly increased risk of death compared with patients waiting for CABG alone (adjusted odds ratio 1.88, 95% confidence interval (CI) 1.23 to 2.88, p = 0.004). Results were similar for patients waiting for combined valve and CABG procedures compared with those who were waiting for isolated CABG. Independent risk factors for death while waiting for isolated CABG included: impaired left ventricular function (odds ratio 2.47, 95% CI 1.59 to 3.84, p < 0.001); advancing age (for each decade, odds ratio 1.41, 95% CI 1.10 to 1.80, p = 0.007); male sex (odds ratio 1.95, 95% CI 1.00 to 3.81, p = 0.05); and waiting longer than the maximum time recommended in Canadian guidelines for a patient's clinical profile (odds ratio 1.59, 95% CI 1.01 to 2.51, p = 0.044). After scaling waiting time to surgery or death continuously in days, the same predictors emerged.Conclusions-Patients waiting for valve surgery have a higher risk of death than patients waiting for isolated CABG. Guidelines to promote safer and fairer queuing for non-CABG cardiac surgery are needed. Shorter waiting Lists, better compliance with existing guidelines, and guideline revisions to upgrade patients with left ventricular dysfunction could generate additional reductions in the already low risk of death for patients waiting for isolated CABG.