Sobolev Boris, Kuramoto Lisa, Levy Adrian, Hayden Robert
Department of Health Care and Epidemiology, University of British Columbia, Canada.
Clin Invest Med. 2006 Aug;29(4):193-200.
To compare the cumulative incidence of emergency surgery between two groups of patients classified according to the length of wait lists at the time of their registration for coronary artery bypass grafting (CABG) and to test for significant differences in the risk of emergency surgery resulting from registration on a longer wait list.
A prospective study of all adult British Columbia residents who registered to undergo isolated CABG. We compared the time-dependent cumulative incidence for undergoing planned surgery through unplanned emergency admission before or during a certain wait-list week between two categories of wait-list size. The list size was a simple count of patients with higher or equal urgency to undergo CABG who were on a wait list at the time of registration of a new patient.
Wait lists with one month or less of clearance time were observed in all urgent patients and were more prevalent in semi-urgent than non-urgent patients (79.1% vs 44.7%, respectively). The patients registered on a list with a clearance time of more than one month had a rate of unplanned emergency admission similar to those on a list with a clearance time of one month or less, OR = 1.07 (95% CI, 0.78-1.47) after adjustment for age, sex, comorbidity, calendar period, urgency and week on the list. During fifty-two weeks of the wait-list follow-up, an equal proportion of patients underwent unplanned emergency surgery after registration on lists in both clearance-time categories, OR = 1.03 (95% CI, 0.78-1.37) after adjustment. The number of patients who underwent CABG without having been registered on a wait list in the same hospital exerted no independent effect.
The length of a wait list at registration had no effect on the probability that a semi-urgent or non-urgent patient would undergo CABG through unplanned emergency admission before or during a certain wait-list week.
比较两组根据冠状动脉搭桥术（CABG）登记时等待名单长度分类的患者进行急诊手术的累积发生率，并检验登记在较长等待名单上导致急诊手术风险的显著差异。
对所有登记接受单纯CABG的成年不列颠哥伦比亚省居民进行前瞻性研究。我们比较了在某一等待名单周之前或期间，通过非计划急诊入院进行计划手术的时间依赖性累积发生率，这两类等待名单规模不同。名单规模是对在新患者登记时处于等待名单上、进行CABG紧迫性更高或相同的患者数量的简单计数。
在所有紧急患者中均观察到清除时间为一个月或更短的等待名单，在半紧急患者中比非紧急患者更普遍（分别为79.1%和44.7%）。登记在清除时间超过一个月的名单上的患者，在调整年龄、性别、合并症、日历时间段、紧迫性和名单上的周数后，非计划急诊入院率与登记在清除时间为一个月或更短的名单上的患者相似，比值比（OR）=1.07（95%置信区间[CI]，0.78 - 1.47）。在等待名单随访的52周内，在两个清除时间类别名单上登记后，进行非计划急诊手术的患者比例相等，调整后OR = 1.03（95%CI，0.78 - 1.37）。在同一家医院未登记在等待名单上而进行CABG的患者数量没有独立影响。
登记时等待名单的长度对半紧急或非紧急患者在某一等待名单周之前或期间通过非计划急诊入院进行CABG的概率没有影响。
