The Surge After the Surge: Cardiac Surgery Post-COVID-19

Area of Science:

• Cardiovascular Surgery
• Public Health
• Health Systems Management

Background:

• The COVID-19 pandemic led to substantial reductions in adult cardiac surgery case volumes.
• Non-urgent cardiac procedures were postponed, creating a growing backlog of deferred cases.
• A critical need exists to address this backlog efficiently once pandemic restrictions ease.

Purpose of the Study:

• To investigate the impact of varying levels of increased hospital operating capacity on clearing the backlog of deferred adult cardiac surgery cases.
• To model the time required to eliminate the surgical backlog under different post-pandemic capacity scenarios.

Main Methods:

• Data were collected from 4 cardiac surgery programs across 2 health systems.
• Baseline and pandemic-period case rates were recorded.
• A mathematical model was developed to quantify the cumulative surgical backlog and predict backlog clearance time based on projected pandemic duration and increased operating capacity.

Main Results:

• Cardiac surgery volumes decreased to 54% of baseline levels during the pandemic.
• Clearing the backlog in one month would require 216%–263% of baseline monthly volume, depending on service restoration timing.
• The time to clear the backlog ranged from 1 to 8 months, contingent on post-COVID hospital capacity and service restoration dates.

Conclusions:

• Post-pandemic cardiac surgical operating capacity is a critical determinant of backlog clearance time.
• Insufficient operating capacity can lead to significant delays, potentially increasing patient morbidity and mortality.
• Restoring only pre-pandemic operating capacity is insufficient to clear the accumulated backlog of deferred cardiac surgeries.