Waiting times and death on the waiting list for coronary artery bypass operation. Experiences in Munich with over 1,000 patients]

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.