Manji Rizwan A, Jacobsohn Eric, Grocott Hilary P, Menkis Alan H
Department of Surgery; Department of Anaesthesia, Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada.
Hosp Pract (1995). 2013 Aug;41(3):15-22. doi: 10.3810/hp.2013.08.1064.
In certain health care systems, patients wait for non-emergency services. Although waiting may not be considered acceptable, the delay may allow for patient optimization, such as giving time for "toxic" agents to be cleared, that could improve outcomes. We sought to determine the relationship between wait times and outcomes in in-hospital patients undergoing urgent coronary artery bypass graft (CABG) surgery.
A prospectively collected database of consecutive, medically urgent, but clinically stable patients undergoing CABG surgery from 1995 to 2007, was analyzed. A total of 3067 patients with need for urgent CABG surgery with various in-hospital wait times (n = 440, 0-2 days; n = 799, 3-5 days; n = 1317, 6-10 days; n = 511, 11-15 days) were included. There were no differences in mortality, intensive care unit (ICU) or post-surgery hospital length of stay (LOS) among the patient groups. Multivariate logistic regression analysis revealed that wait time was not associated with mortality (P = 0.625). Due to changes in the nonsurgical management of coronary artery disease, a separate analysis of patients, from 2002 to 2007, was also performed to explore contemporary results. In the latter subset, 1495 patients (n = 175, 341, 720, 259, in the same 4 respective wait-time groups) were included; the 0-2 days patient group underwent more blood transfusions (50% vs 38%; P = 0.01), prolonged ventilation (6% vs 2%; P = 0.05), post-operative dialysis (2% vs 0%; P = 0.08), and longer ICU LOS (26 vs 23 hours; P = 0.02) compared with the 3-5 days patient group. The Society of Thoracic Surgeons mortality risk scores of the 0-2 days and 3-5 days groups were the same (1.5%). Multivariate regression analysis revealed that increased wait time was associated with fewer patients requiring blood transfusion (P < 0.05) for CABG surgery.
Waiting for in-hospital urgent CABG surgery does not lead to worse patient outcomes and may, in fact, reduce the procedural and medical risks of postoperative blood transfusions, prolonged ventilation, dialysis, and shorten ICU LOS.
在某些医疗保健系统中，患者需要等待非紧急服务。尽管等待可能不被认为是可接受的，但这种延迟可能使患者状况得到优化，比如有时间让“毒性”物质清除，这可能改善治疗结果。我们试图确定在接受紧急冠状动脉旁路移植术（CABG）的住院患者中，等待时间与治疗结果之间的关系。
分析了一个前瞻性收集的数据库，该数据库包含1995年至2007年连续接受CABG手术的医学紧急但临床稳定的患者。共有3067例需要紧急CABG手术且有不同住院等待时间的患者纳入研究（n = 440，等待0 - 2天；n = 799，等待3 - 5天；n = 1317，等待6 - 10天；n = 511，等待11 - 15天）。各患者组之间在死亡率、重症监护病房（ICU）或术后住院时间（LOS）方面无差异。多因素逻辑回归分析显示等待时间与死亡率无关（P = 0.625）。由于冠状动脉疾病非手术治疗的变化，还对2002年至2007年的患者进行了单独分析以探究当代结果。在后者亚组中，纳入了1495例患者（在相同的4个各自等待时间组中分别为n = 175、341、720、259）；与等待3 - 5天的患者组相比，等待0 - 2天的患者组输血更多（50%对38%；P = 0.01）、通气时间延长（6%对2%；P = 0.05）、术后透析（2%对0%；P = 0.08）以及ICU住院时间更长（26小时对23小时；P = 0.02）。等待0 - 2天和3 - 5天组的胸外科医师协会死亡风险评分相同（1.5%）。多因素回归分析显示等待时间增加与CABG手术中需要输血的患者减少相关（P < 0.05）。
等待住院紧急CABG手术不会导致更差的患者治疗结果，事实上可能降低术后输血、通气时间延长、透析的手术及医疗风险，并缩短ICU住院时间。
