Chirurgie mini invasive et robotique : les news: septembre 2005

This white paper (scientific press) is not specifically about minimally invasively performed Coronary Artery Bypass Grafts.

Abstract (provisional):

"Background

The proportion of patients who undergo surgery within a clinically safe time is an important performance indicator in health systems that use wait lists to manage access to care. However, little is known about chances of on-time surgery according to variations in existing demand. We sought to determine what proportion of patients have had late coronary bypass surgery after registration on wait lists of different size in a network of hospitals with uniform standards for timing of surgery.

Methods

Using records from a population-based registry, we studied wait-list times prospectively collected in a cohort of patients registered on wait lists for coronary artery bypass grafting procedures. We compared the number of weeks from registration to surgery against target access times established for three urgency groups. The chances of undergoing surgery within target time have been evaluated in relation to wait-list size at registration and the number of surgeries performed without registration on a wait list.

Results

In 1991-2001, two in three patients were at risk of late surgery when registered on wait lists for isolated coronary bypass procedures in British Columbia, Canada. Although urgent patients had never seen a wait list with clearance time exceeding one week, the odds of on-time surgery were reduced by 25%, odds ratio [OR] = 0.75 (95% confidence interval [CI] 0.65-0.87) for every additional operation performed without registration on a list. When the wait list at registration required a clearance time of over one month, semi-urgent patients had 51% lower odds of on-time surgery as compared to lists with clearance time less than one week, OR = 0.49 (95%CI 0.41-0.60), after adjustment for age, sex, comorbidity, calendar period, hospital and week on the list. In the non-urgent group, the odds were 69% lower, OR = 0.31 (95%CI 0.20-0.47). Every time an operation in the same hospital was performed without registration on a wait list, the odds of on-time surgery for listed patients were reduced by 7%, OR = 0.93 (95%CI 0.91-0.95) in the semi-urgent group, and by 10%, OR = 0.90 (95%CI 0.87-0.94), in the non-urgent group.

Conclusions

Chances of late surgery increase with the wait-list size for semi-urgent and non-urgent patients needing coronary bypass surgery.

The weekly number of patients who move immediately from angiography to the operation without registration on a wait list reduced chances of surgery within target time in all urgency groups of listed patients. When advising patients who will be placed on the wait list about the expected time to treatment, hospital managers should take into account the current list size as well as the weekly number of patients who require CABG (1) immediately after undergoing coronary angiography."

(1) CABG = Coronary Artery Bypass Graft

Sources:
BMC Health Services Research 2005. Authors: Boris G Sobolev ,
Adrian R Levy , Lisa Kuramoto and Robert Hayden.
==> BioMedCentral.com

"La médiathèque de Fontenay-aux-Roses vous donne rendez-vous le
jeudi 22 septembre 2005 à 20H00,
pour une rencontre avec Rodolphe GELIN responsable du Service cognitique, robotique et interaction au CEA Fontenay-aux-Roses. Cette rencontre aura pour thème :
Aux frontières du réel.

Du bureau d’étude à la chirurgie il est possible aujourd’hui de se projeter dans un environnement complètement virtuel, de manipuler des objets et d’en ressentir la texture, le poids et même le bruit lorsqu’ils se heurtent ! Grâce au progrès des techniques de simulation numérique, des performances graphiques et de la puissance de calcul des ordinateurs, les chercheurs explorent la possibilité de créer des environnements en réalité virtuelle pour le développement, par exemple, de robots chirurgicaux, d’architectures audacieuses ou de moteurs innovants."