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. 2022 Mar;113(3):738-746.
doi: 10.1016/j.athoracsur.2021.07.015. Epub 2021 Jul 31.

The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717 103 Patients

Tom C Nguyen  1 , Vinod H Thourani  2 , Alexander P Nissen  3 , Robert H Habib  4 , Joseph A Dearani  5 , Allan Ropski  4 , Juan A Crestanello  5 , David M Shahian  6 , Jeffrey P Jacobs  7 , Vinay Badhwar  8
Affiliations

The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717 103 Patients

Tom C Nguyen et al. Ann Thorac Surg. 2022 Mar.

Abstract

Background: COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on regional and national levels.

Methods: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried from January 1, 2018, to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020, to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze risk-adjustable mortality.

Results: The study analyzed 717 103 adult cardiac surgery patients and more than 20 million COVID-19 patients. Nationally, there was a 52.7% reduction in adult cardiac surgery volume and a 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes did not return to baseline, indicating a COVID-19-associated deficit of cardiac surgery patients.

Conclusions: This large analysis of COVID-19-related impact on adult cardiac surgery volume, trends, and outcomes found that during the pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first COVID-19 surge, with a concurrent increase in observed-to-expected 30-day mortality.

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Figures

Figure 1
Figure 1
United States map demonstrates the 9 The Society of Thoracic Surgeons regions and their respective contributions to the overall study cohort.
Figure 2
Figure 2
Case decline in the United States (US) with overlayed number of new regional COVID-19 cases during the same time frame.
Figure 3
Figure 3
United States (US) regional COVID-19 rates per million population.
Figure 4
Figure 4
Regional (colors) and United States (US) (solid black) COVID-19 trends, normalized per million population. Any deviation of the colored line from the black line indicates regional rates of COVID-19 that are increasing greater than the national rate.
Figure 5
Figure 5
United States (US) regional monthly cardiac surgery volumes as a percentage of mean volumes for the previous monthly value.
Figure 6
Figure 6
Mid-Atlantic regional case decline with overlayed number of new regional COVID-19 cases during the same time frame.
Figure 7
Figure 7
Mortality observed/expected (O/E) ratios for (A) all risk-adjustable operations and for (B) isolated coronary artery bypass grafting in the Mid-Atlantic and New England regions vs all other regions.
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