The Weekend CABG

Coronary artery bypass grafting is one of the simpler cardiac surgeries and is rarely an emergency. In patients with multi-vessel coronary artery disease, the surgeon takes veins from the leg or an artery from the chest to bypass the obstructions, allowing bloodflow distal to the blockages. While taking weekend call on this rotation, I have had two scheduled CABG surgeries.

I don't mind doing cases on the weekend, and indeed, it is from these two bypass surgeries that I became more and more independent with cardiac anesthesia. However, I wanted to write a post about the drive for these surgeries which was financial in nature. Medicine's ideals ask us to be blind to money, but the reality is that money affects everything. The two patients couldn't have been more different, however; one patient was a VIP and the other was an uninsured gentleman in the coronary care unit. For the first, expediting his surgery was a matter of patient preference so he would not have to be in the hospital longer than necessary. For the second, doing the surgery earlier would reduce the cost of ICU care. Of course, the cost argument must be balanced to the fact that staffing operating rooms outside business hours is more expensive.

Is this right? I don't agree with it. I think surgeries should be blind to financial pressures and this means we should be doing more on weekends. Why wait until Monday to do a surgery that can be done Saturday? If an inpatient is medically optimized, then waiting simply incurs more cost and increases hospital complications. It shouldn't just be the rich self-pay patient or the indigent one who cannot pay who get expedited operations. The decision to do something on a weekend should be based on medical circumstance. I understand that no one wants to work on the weekends, and neither do I, but this business is one of doing the best thing for patients, and waiting is no good.