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In and Out - what is the real impact of the “waiting setting” in cardiac surgical patients?
Session:
Painel 11 - Cardiologia Intervenção 3
Speaker:
Teresa Mota
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Posters
FP Number:
---
Authors:
Teresa Faria Da Mota; João De Sousa Bispo; Pedro Oliveira De Azevedo; Raquel Menezes Fernandes; Hugo Alex Costa; Nuno Marques; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction: </strong>Cardiac surgical patients are an heterogenous population, who cross cardiologists’ paths in many different settings. While in most cases the decision on where to wait for surgery is straightforward, some patients that leave us doubting; additionally, the social and economic pressures to shorten admission duration have never been heavier.</p> <p><strong>Objectives: </strong>The authors meant to evaluate the impact of the setting where patients wait for cardiac surgery (in-hospital or ambulatory), in outcomes such as mortality and hospital readmission. Characterization of both populations, as well as comparison between different types<br /> of procedures was also performed.</p> <p><strong>Methods: </strong>The authors present a monocentric, retrospective, observational and analytical study, which included all patients assisted at our Cardiology Department who were referred to cardiac surgery between January 1st 2016 and December 31st 2018. Clinical data and outcomes were collected through clinical files scrutiny. Patients were divided according to the place where they waited for surgery (inpatients vs. outpatients). Statistical analysis was performed using SPSS 24,0 software. For analytical inferences, a significance level<br /> of 0,05 was used.</p> <p><strong>Results:</strong> A total of 591 patients were included in the analysis, 28,9% of which were female, with a mean age of 68,6±11,36 years. Considering the different types of procedures, 41,9% of patients were referred to valvular surgery, 37,1% to CABG, 14,4% to both and 6,6% to other interventions. Regarding the “waiting setting”, 64,1% of patients awaited surgery at home, while 34% remained hospitalized; patients who were referred during hospital admission were more likely to remain hospitalized than patients referred through outpatient settings (71,4% vs 28,6%, p< 0,001). Inpatients were more frequently referred to CABG (66,2%), while outpatients had mainly a valvular surgical indication (56,3%). The first were younger (66,6 vs. 69,5 years, p=0,004), and had a higher incidence of smoking (24,5% vs. 15,5%), dyslipidaemia (68,5% vs. 59,5%, p=0,041) and recent Acute Myocardial Infarction (68,2% vs. 15%, p> 0,001), but no<br /> differences were detected regarding other CV risk factors and previous cardiac surgery. Inpatients waited significantly less for surgery, when compared to outpatients (9,69 vs. 132 days, p<0,001). On a comprehensive analysis, patients who stayed hospitalized while waiting for surgery suffered lower mortality during that period of time (0,5% vs. 6,3%, p=0,001) and summed less hospital readmissions (21,6% vs. 78,4%, p<0,001).</p> <p><strong>Conclusions: </strong>In patients referred for cardiac surgery, the “waiting setting” proved to be a statistically significant factor, with impact on mortality before surgery and on hospital readmissions; time until surgery may have a crucial influence in the outcomes analysed.</p>
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