The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant decline in the volume of overall heart surgeries, as well as an increase in deaths following coronary artery bypass grafting, according to research presented at the 57th Annual Meeting of the Society of Thoracic Surgeons (STS).

"This study was a true herculean analysis and tour de force that showed the COVID effect on adult cardiac surgery volume, trends, and outcomes," said Tom C. Nguyen, MD, the chief of the division of adult cardiothoracic surgery and the Helen and Charles Schwab distinguished professor of surgery in the Department of Surgery at the University of California San Francisco, in a press release. "The pandemic has changed the world as we know it, causing a dramatic drop in adult cardiac surgery volume and worsening patient outcomes."

Nguyen and his colleagues conducted their study by examining data from the STS Adult Cardiac Surgery Database between January 1, 2018, and June 30, 2020, and the Johns Hopkins COVID-19 Dashboard between February 1, 2020, and January 1, 2021. In order to determine how the pandemic affected adult cardiac surgery on both national and regional levels, they looked at data from 717,103 adult cardiac surgery patients and more than 20 million COVID-19 patients.

"Only the STS National Database has the level of granularity, COVID variables, and longitudinal follow-up to answer the questions posed in this important study," Nguyen said in the press release. "Our research also analyzed data by regions to get an idea of how specific areas did during the COVID pandemic."

The results of the study showed that there was a 53% decrease across the country in the volume of adult cardiac surgeries conducted compared with 2019 data, as well as a 65% decrease in elective cases. Non-elective cases were also found to be impacted by the pandemic, resulting in a 40% decrease in surgeries.

Additionally, the researchers found that regardless of the procedure—whether it was isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), isolated mitral valve replacement (MVR), CABG+AVR, CABG+MVR, isolated MV repair, or CABG+MV repair—the data still showed a 54% decline in overall case volume when compared to 2019.

Specifically, the Mid-Atlantic area, including New York, New Jersey, and Pennsylvania, was found to be one of the regions that was the most impacted by the COVID-19 crisis in terms of surgery volume, with a 71% decrease in overall cases, 75% decrease in elective cases, and a 59% decrease in non-elective cases. Another region that was significantly affected was the New England region, including Maine, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island, which demonstrated a 63% decrease in volume of overall cases.

Before the COVID-19 pandemic, both the Mid-Atlantic and New England regions showed excellent patient outcomes with an observed-to-expected (O/E) ratio that was less than 1, which demonstrates that the mortality rate experienced by patients was better than what would normally be expected. However, as a result of the COVID-19 pandemic, the O/E increased by 110% for all adult cardiac procedures and increased by 167% for isolated CABG, which demonstrates that more patients died than is normally expected, according to the study.

Although the researchers noted that the data do not directly answer questions regarding the reasons for the increased mortality, surgeons have explained in the past that they have needed to limit their operations to the most urgent coronary bypass cases and to those patients who are sicker and thus need more urgent care during the pandemic.

"These numbers should not serve as a deterrent to patients seeking care for chest pain or other cardiac symptoms," said Robbin G. Cohen, MD, MMM, from Keck School of Medicine of the University of Southern California in Los Angeles, in the press release. "If anything, they are a warning to get into the system as soon as possible."

When the research was presented at STS, the total COVID-19 cases globally was 95.4 million with more than 2 million global deaths. In the United States alone, there were more than 24 million cases and approximately 400,000 deaths.

Over the past year during the pandemic, the practice of cardiothoracic surgery has not been immune to the impact of the health crisis, with the abrupt cessation of surgery in mid-March 2020 resulting in far-reaching effects on patient health outcomes, according to the study authors.

"We clearly demonstrated that if you have heart surgery during COVID, you have an increased risk of morbidity and mortality," Nguyen said in the press release. "No doubt that COVID hit us hard."

Nguyen explained further that this study is one of the first of more focused analyses that will take place in order to examine trends and outcomes of the pandemic on patient outcomes, as well as assess the effects of COVID-19 on specific adult cardiac procedures, such as aortic dissections.

REFERENCE
'COVID effect' leads to fewer heart surgeries, more patient deaths. Chicago, IL: The Society of Thoracic Surgeons; January 30, 2021. https://sciencesources.eurekalert.org/pub_releases/2021-01/tsot-el012821.php. Accessed February 19, 2021.