The Waiting 4 Surgery study: burden of in-hospital care

Abstract Introduction Patients with coronary artery and valvular diseases with surgical indication represent a significant proportion of hospitalizations. The Waiting 4 Surgery study (W4S) aims to better study this group of patients, their burden of hospital care and identify those with event-free admissions. Purpose In this work, we analyze both the economical and hospital-care burden of this group of patients. Methods Retrospective study of consecutive patients admitted between 2019 and 2021 with coronary artery and/or aortic valve diseases waiting for coronary artery bypass graft (CABG), aortic valve replacement (AVR; surgical or percutaneous) or both. Total admission time and the cost associated with the hospitalization were analyzed. For event-free hospitalization, the following events were considered: death, re-infarction, cardiac pulmonary arrest (CPA), stroke, ventricular tachycardia, acute heart failure (AHF), rest chest pain and reintroduction of intravenous (IV) drugs. We performed a secondary cost analysis for patients with event-free hospitalization after the first 5 days of admission. Results Total of 184 patients were included, mean age 67.9 years, 70.1% male, 71.2% submitted to CABG and 20.7% to AVR (6.5% to both). During admission 23.9% of patients reintroduced IV drugs, 20.1% had chest pain, 5.4% had AHF and 2.2% had CPA. No deaths, strokes of re-infarctions were observed. The total time of hospitalization was 3 259 patients/days, representing an occupation rate of 18.6% and a total cost of 1 898 447€ (10 318€/patient and 632 816€/year). Mean admission time was 17.6 days. Total cost for CABG and AVR patients was 1 479 613€ and 594 562€, respectively. Total of 115 patients had an event-free hospitalization (62.5%). The total time of event-free hospitalization was 1 650 patients/days, representing an occupation rate of 9.42% and a total cost of 979 710€ (6 575€/patient and 326 570€/year). Mean event-free admission time was 14.3 days. Total cost for CABG and AVR in event-free patients was 863 155€ and 223 258€, respectively. Conclusion The W4S study demonstrates the impact patients waiting for surgery represent in hospital care: a very high economic and logistic burden. The majority of patients showed an event-free admission, and identifying such patients for early discharge and ambulatory management together with surgical centers should be a priority.