Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality.
Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality.
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DOI：
10.1186/1472-6963-8-185
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发表时间：
2008-09-19
影响因子：
2.8
通讯作者：
FitzGerald MJ
中科院分区：
文献类型：
--
作者：
Sobolev BG;Fradet G;Hayden R;Kuramoto L;Levy AR;FitzGerald MJ
许多医疗保健系统现在使用优先等待名单来安排选择性冠状动脉旁路移植术（CABG）手术，但尚未有任何直接的估计，以减少住院死亡率提供了确保手术在推荐的时间段内进行。我们采用基于人群的登记研究来识别在加拿大不列颠哥伦比亚省接受孤立性冠状动脉旁路移植术的确诊冠心病患者。我们研究了等待手术时间超过推荐时间的患者（需要半紧急手术的患者为6周，需要非紧急手术的患者为12周）接受CABG住院期间的术后生存率是否存在显著差异。在7316例接受CABG的患者中，97例在同一医院住院期间死亡，全省出院时死亡率为1.3%。在同一入院期间死亡的患者比例为1.0%（2675例患者中有27例死亡），在推荐时间内接受治疗的患者中为1.5%（4641例患者中有70例死亡），CABG延迟。在调整年龄、性别、解剖结构、合并症、日历周期、住院时间和入院方式后，早期CABG患者发生院内死亡的可能性仅为延迟CABG患者的2/3（比值比0.61; 95%置信区间[CI] 0.39 - 0.96）。手术前每延迟一个月，院内死亡几率呈线性增加5%的趋势，调整后OR = 1.05（95%CI 1.00 - 1.11）。我们发现，对于需要半紧急或非紧急治疗的患者，在顾问外科医生认为可接受的时间内进行手术血运重建可获得显著的生存益处。
Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We 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. Among 7316 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 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) 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 as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11). We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.
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影响因子：
9.7
作者：
NAYLOR, CD
通讯作者：
NAYLOR, CD
影响因子：
105.7
作者：
Bridgewater, B
通讯作者：
Bridgewater, B
DOI：
10.1007/bf03403934
发表时间：
1998-07-01
影响因子：
4.3
作者：
Chamberlayne, R;Green, B;Sheps, SB
通讯作者：
Sheps, SB
影响因子：
2.3
作者：
LEVYADUN, S;ALONI, R
通讯作者：
ALONI, R
影响因子：
5.7
作者：
Morgan, CD;Sykora, K;Naylor, CD
通讯作者：
Naylor, CD