Sobolev Boris G, Fradet Guy, Kuramoto Lisa, Rogula Basia
The University of British Columbia, 828 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.
J Cardiothorac Surg. 2013 Apr 11;8:74. doi: 10.1186/1749-8090-8-74.
Our objective was to evaluate the effect of delays on adverse events while waiting for coronary artery bypass grafting (CABG).
An observational study that prospectively followed patients from registration on a wait list to removal for planned surgery, death while waiting, or unplanned emergency surgery. The population-based registry provided data on 12,030 patients with a record of registration on a wait list for first-time isolated CABG surgery between 1992 and 2005.
In total, 104 patients died and 382 patients underwent an emergency surgery before planned CABG. The death rate was 0.5 per 1000 patient-weeks in the semiurgent group and 0.6 per 1000 patient-weeks the nonurgent group, adjusted OR = 1.07 (95% confidence interval [CI] 0.69-1.65). The emergency surgery rate of 1.2 per 1000 patient-weeks in the nonurgent group was lower compared to 2.1 per 1000 patient-weeks in the semiurgent group (adjusted OR = 0.72, 95% CI 0.54-0.97). However, the nonurgent group had a greater cumulative incidence of preoperative death than the semiurgent group for almost all weeks on the wait list, adjusted OR = 1.92 (95% CI 1.25-2.95). The surgery rate was 1.2 per 1000 patient-weeks in the nonurgent group and 2.1 per 1000 patient-weeks in the semiurgent group, adjusted OR = 0.72 (95% CI 0.54-0.97). The cumulative incidence of emergency surgery before planned CABG was similar in the semiurgent and nonurgent groups, adjusted OR = 0.88, (95% CI 0.64-1.20).
Despite similar death rates in the semiurgent and nonurgent groups, the longer waiting times in the nonurgent group result in a greater cumulative incidence of death on the wait list compared to that in the semiurgent group. These longer waiting times also offset the lower rate of emergency surgery before planned admission in the nonurgent group so that the cumulative incidence of the emergency surgery was similar in both groups.
我们的目标是评估等待冠状动脉搭桥术（CABG）期间延迟对不良事件的影响。
一项观察性研究，前瞻性地跟踪患者从列入等待名单登记到因计划手术而移除、等待期间死亡或进行非计划急诊手术的情况。基于人群的登记处提供了1992年至2005年间12,030例首次孤立性CABG手术等待名单登记记录患者的数据。
共有104例患者死亡，382例患者在计划CABG之前接受了急诊手术。半紧急组的死亡率为每1000患者周0.5例，非紧急组为每1000患者周0.6例，校正后的比值比（OR）=1.07（95%置信区间[CI]0.69 - 1.65）。非紧急组的急诊手术率为每1000患者周1.2例，低于半紧急组的每1000患者周2.1例（校正后的OR = 0.72，95%CI 0.54 - 0.97）。然而，在等待名单上的几乎所有周，非紧急组术前死亡的累积发生率均高于半紧急组，校正后的OR = 1.92（95%CI 1.25 - 2.95）。非紧急组的手术率为每1000患者周1.2例，半紧急组为每1000患者周2.1例，校正后的OR = 0.72（95%CI 0.54 - 0.97）。计划CABG之前急诊手术的累积发生率在半紧急组和非紧急组中相似，校正后的OR = 0.88，（95%CI 0.64 - 1.20）。
尽管半紧急组和非紧急组的死亡率相似，但与半紧急组相比，非紧急组更长的等待时间导致等待名单上死亡的累积发生率更高。这些更长的等待时间也抵消了非紧急组计划入院前较低的急诊手术率，因此两组急诊手术的累积发生率相似。
