Cardiothoracic department, Santa Cruz Hospital, Portugal.
Port J Card Thorac Vasc Surg. 2024 May 13;31(1):17-22. doi: 10.48729/pjctvs.422.
Cardiac disease is associated with a risk of death, both by the cardiac condition and by comorbidities. The waiting time for surgery begins with the onset of symptoms and includes referral, completion of the diagnosis and surgical waiting list (SWL). This study was conducted during the COVID-19 pandemic, which affected surgical capacity and patients' morbidities.
The cohort includes 1914 consecutive adult patients (36.6% women, mean age 67 ±11 years), prospectively registered in the official SWL from January 2019 to December 2021. We analyzed waiting times ranging from 4 days to one year to exclude urgencies and outliers. Priority was classified by the national criteria for non-oncologic or oncology surgery.
During the study period, 74% of patients underwent surgery, 19.2% were still waiting, and 4.3% dropped out. Most cases were valvular (41.2%) or isolated bypass procedures (34.2%). Patients were classified as non-priority in 29.7%, priority in 61.8%, and high priority in 8.6%, with significantly different SWL mean times between groups (p<0.001). The overall mean waiting time was 167 ± 135 days. Mortality on SWL was 2.5%, or 1.1 deaths per patient/weeks. There were two mortality independent predictors: age (HR 1.05) and the year 2021 versus 2019 (HR 2.07) and a trend toward higher mortality in priority patients versus non-priority (p=0.065). The overall risk increased with time with different slopes for each year. Using the time limits for SWL in oncology, there would have been a significant risk reduction (p=0.011).
The increased risk observed in 2021 may be related to the pandemic, either by increasing waiting time or by direct mortality. Since risk stratification is not entirely accurate, waiting time emerges as the most crucial factor influencing mortality, and implementing stricter time limits could have led to lower mortality rates.
心脏疾病与死亡风险相关，既与心脏状况有关，也与合并症有关。手术的等待时间从症状发作开始，包括转诊、完成诊断和手术等待名单（SWL）。这项研究是在 COVID-19 大流行期间进行的，大流行影响了手术能力和患者的合并症。
该队列包括 1914 名连续的成年患者（36.6%为女性，平均年龄 67±11 岁），他们在 2019 年 1 月至 2021 年 12 月期间在官方 SWL 中进行了前瞻性登记。我们分析了从 4 天到 1 年不等的等待时间，以排除紧急情况和异常值。优先级是根据非肿瘤或肿瘤手术的国家标准进行分类的。
在研究期间，74%的患者接受了手术，19.2%仍在等待，4.3%退出。大多数病例为瓣膜性（41.2%）或孤立旁路手术（34.2%）。患者被归类为非优先级的占 29.7%，优先级的占 61.8%，高优先级的占 8.6%，各组之间的 SWL 平均时间差异有统计学意义（p<0.001）。总的平均等待时间为 167±135 天。SWL 的死亡率为 2.5%，即每例患者/周死亡 1.1 人。有两个独立的死亡率预测因素：年龄（HR 1.05）和 2021 年与 2019 年（HR 2.07），以及优先级患者与非优先级患者的死亡率呈上升趋势（p=0.065）。总体风险随时间增加，每年的斜率不同。使用肿瘤学的 SWL 时间限制，死亡率将显著降低（p=0.011）。
2021 年观察到的风险增加可能与大流行有关，要么是因为等待时间的延长，要么是因为直接导致死亡率的增加。由于风险分层并不完全准确，等待时间成为影响死亡率的最关键因素，实施更严格的时间限制可能会降低死亡率。
