Carrier M, Pineault R, Tremblay N, Pelletier L C
Department of Surgery, Montreal Heart Institute, Que.
CMAJ. 1993 Oct 15;149(8):1117-22.
To assess the effect of the waiting period before elective open-heart surgery on patient outcomes.
Retrospective analysis.
The Montreal Heart Institute, a referral centre in cardiology and cardiac surgery.
All 568 patients who underwent open-heart surgery on an elective basis or following urgent admission or interhospital transfer between October 1991 and February 1992.
In-hospital death rate, incidence of postoperative complications, length of stay in the intensive care unit (ICU) and total length of hospital stay.
A total of 206 patients (151 men and 55 women with an average age of 59.0 [standard error of the mean (SEM) 1] years) underwent elective surgery, and 362 patients (264 men and 98 women with an average age of 62.0 [SEM 1] years) underwent urgent surgery. The mean wait for elective surgery was 2.8 (SEM 0.2) months. There was no significant difference between the two groups in the in-hospital death rate (4% v. 4%), the average length of stay in the ICU (4.4 [SEM 0.2] days v. 5.8 [SEM 1] days) or the average total length of hospital stay (9.0 [SEM 0.4] days v. 9.1 [SEM 1] days). As would be expected, postoperative complications developed in significantly more patients in the urgent group (27%) than the elective group (18%) (p = 0.02). Eight patients were admitted on an urgent basis for surgery owing to worsening symptoms or acute myocardial infarction after a mean wait of 4.6 months. One patient died suddenly at home 1 month after medical investigation while awaiting repeat coronary artery bypass grafting. Among the 206 patients who underwent elective surgery there was no relation between waiting time and adverse clinical outcomes after surgery.
The results suggest that the wait before elective open-heart surgery had no effect on patient outcome after surgery in our institution. A policy of a short waiting period before elective open-heart surgery for patients whose condition is stable is safe and acceptable only if rapid access to medical and surgical treatment is available should it become necessary.
评估择期心脏直视手术前等待期对患者预后的影响。
回顾性分析。
蒙特利尔心脏研究所，一家心脏病学和心脏外科转诊中心。
1991年10月至1992年2月期间所有568例行择期心脏直视手术、紧急入院或院际转运后接受手术的患者。
住院死亡率、术后并发症发生率、重症监护病房（ICU）住院时间和总住院时间。
共有206例患者（151例男性和55例女性，平均年龄59.0[平均标准误（SEM）1]岁）接受择期手术，362例患者（264例男性和98例女性，平均年龄62.0[SEM 1]岁）接受急诊手术。择期手术的平均等待时间为2.8（SEM 0.2）个月。两组在住院死亡率（4%对4%）、ICU平均住院时间（4.4[SEM 0.2]天对5.8[SEM 1]天）或平均总住院时间（9.0[SEM 0.4]天对9.1[SEM 1]天）方面无显著差异。正如预期的那样，急诊组术后并发症的发生率（27%）显著高于择期组（18%）（p = 0.02）。8例患者因症状加重或急性心肌梗死在平均等待4.6个月后紧急入院接受手术。1例患者在医学检查后1个月在家中等待再次冠状动脉搭桥手术时突然死亡。在206例接受择期手术的患者中，等待时间与术后不良临床结局之间无关联。
结果表明，在我们机构，择期心脏直视手术前的等待期对术后患者预后无影响。对于病情稳定的患者，择期心脏直视手术前短等待期的政策只有在必要时能够快速获得医疗和手术治疗的情况下才是安全且可接受的。
