Introduction The demand for cardiac surgery continues to outstrip supply in both jurisdictions on the island of Ireland. In the light of anecdotal reports of increasing numbers of patients who died while waiting for surgery, we analysed the deaths on the contemporary cardiac surgery waiting lists in Northern Ireland.
Methods A prospectively maintained database of patients added to the waiting list between 1st April 2013 and 31stMarch 2015 was interrogated and all patients who were removed without completion of an operation were identified and cross-referenced with dates of death. The results were individually reviewed to exclude duplicate entries and deaths on the operating table or post-operatively. The total number of deaths after cardiac surgery was determined from the separate cardiac surgery database.
Results Over this 2 year period, 36 patients who were on the waiting list for cardiac surgery died prior to surgery. Prioritisation was urgent inpatient in 15 (42%), urgent outpatient in 4 (11%) and routine outpatient in 17 (47%). Urgent inpatients had waiting a mean of 44.6 days (range 14 to 104) at the time of death.
Urgent outpatients had been waiting a mean of 70.75 days (range 21 to 155) and routine outpatients 149.9 days (range 31 to 322). Over the same period, an identical number of patients died after surgery in our unit. Indication for surgery was CABG in 8 (22%), AVR in 11 (31%), AVR&CABG in 12 (33%) and MVR and Other in 5 (15%). Compared to the same categories of surgery actually performed over the same period, this gave a relative risk of death on the waiting list of 0.40 for CABG, 2.26 for AVR, 2.80 for AVR&CABG and 1.90 for MVR and Other.
Conclusion There is an unacceptably high number of deaths on the waiting list for cardiac surgery in Northern Ireland. The majority of patients who die are prioritised as elective. Patients awaiting AVR ± CABG are at greater risk and should, therefore, be prioritised accordingly.
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