Silber S, Mühling H, Dörr R, Zindler G, Preuss A, Stümpfl A
Kardiologische Gemeinschaftspraxis, München.
Herz. 1996 Dec;21(6):389-96.
Short-term and long-term results are the classical parameters for quality assurance in coronary artery bypass graft surgery (CABGS). In contrast, waiting times and the inherent risks of waiting lists are usually neglected. Although the problem of "death on the waiting list" is generally known, related publications are scarce. Therefore, in January 1994, we started a prospective study to document the waiting times and the occurrence of severe complications in our patients waiting for CABGS. Between January 1, 1994 and July 31, 1996, we catheterized 1125 patients with indication for CABGS. 968 patients had social health insurance (SOCL); 157 patients were privately insured (PRIV). The urgency of CABGS was classified as "emergent", "ery urgent" and "less urgent" according to the clinical experience of the responsible cardiologists. All emergency cases could be operated the same day. 69% of the very urgent SOCL patients had to travel beyond the Munich area to be operated, while 84% of the respective PRIV patients were operated in Munich. SOCL patients were therefore separated from their families 4.3 times more frequently then PRIV. Not so urgent SOCL cases were separated from their families 1.8 times more often than PRIV. The mean waiting time for SOCL was 39.5 +/- 39.1 days in 1994, 34.9 +/- 31.5 days in 1995 and 22.7 +/- 16 days in 1996. The corresponding values of PRIV are 19.1 +/- 16.2, 19.8 +/- 14.1 and 17.2 +/- 12.6 days. The risk of dying while waiting for CABGS was 1.3% per month (15/1125). The reduction of waiting times by the factor of two between 1994 and 1996 did not, however, influence the death on the waiting list, because all deaths occurred within 4 weeks after diagnostic catheterization. Our results show that triage practices for patients requiring CABGS are not reliable. To minimize the risk of the "death on the waiting list", CABGS must be offered within a week after diagnostic coronary angiography, even for "elective" cases.
短期和长期结果是冠状动脉搭桥手术（CABGS）质量保证的经典参数。相比之下，等待时间和等待名单所固有的风险通常被忽视。尽管“在等待名单上死亡”的问题广为人知，但相关出版物却很少。因此，1994年1月，我们启动了一项前瞻性研究，以记录等待CABGS的患者的等待时间和严重并发症的发生情况。在1994年1月1日至1996年7月31日期间，我们对1125例有CABGS指征的患者进行了导管插入术。968例患者有社会医疗保险（SOCL）；157例患者为私人保险（PRIV）。根据负责心脏病专家的临床经验，CABGS的紧迫性分为“紧急”、“非常紧急”和“不太紧急”。所有急诊病例均可在当天进行手术。69%的非常紧急的SOCL患者必须前往慕尼黑地区以外的地方进行手术，而84%的相应PRIV患者在慕尼黑进行手术。因此，SOCL患者与家人分离的频率比PRIV患者高4.3倍。不太紧急的SOCL病例与家人分离的频率比PRIV患者高1.8倍。1994年SOCL的平均等待时间为39.5±39.1天，1995年为34.9±31.5天，1996年为22.7±16天。PRIV的相应值分别为19.1±16.2天、19.8±14.1天和17.2±12.6天。等待CABGS期间死亡的风险为每月1.3%（15/1125）。然而，1994年至1996年期间等待时间缩短一半并没有影响等待名单上的死亡情况，因为所有死亡均发生在诊断性导管插入术后4周内。我们的结果表明，对需要CABGS的患者进行分诊的做法并不可靠。为了将“在等待名单上死亡”的风险降至最低，即使是“择期”病例，也必须在诊断性冠状动脉造影后一周内提供CABGS。
