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Adult cardiac surgery during COVID-19 lockdown: Impact on activity and outcomes in a high-volume centre
Joseph Nader1, Amedeo Anselmi1, Jacques Tomasi1
1Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France.
Insights
The COVID-19 lockdown significantly reduced adult cardiac surgery activity by 57%, leading to higher-risk patients and increased operative mortality and postoperative complications. A strategic plan is needed to mitigate these adverse outcomes.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Public Health
Background:
- The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare systems globally.
- Adult cardiac surgery requires intensive care, making it vulnerable to disruptions.
- The COVID-19 outbreak necessitated lockdowns, affecting various medical procedures.
Purpose of the Study:
- To assess the impact of the COVID-19 lockdown on adult cardiac surgery activity.
- To compare surgical outcomes during the lockdown period with the pre-lockdown period of 2019.
- To identify changes in patient risk profiles and procedural characteristics.
Main Methods:
- Prospective observational cohort study comparing March 9–May 10, 2020, with March 9–May 10, 2019.
- Data collected from local certified and national French databases.
- Primary endpoints: operative mortality and postoperative complications.
Main Results:
- Cardiac surgery activity decreased by 57% (105 interventions in 2020 vs. 2019).
- Patients in 2020 were higher risk (higher EuroSCORE II, more endocarditis, recent myocardial infarction, acute aortic syndromes).
- Operative mortality increased (5.7% vs. 1.7%), with more postoperative bleeding, need for mechanical support, and prolonged ventilation.
Conclusions:
- The COVID-19 lockdown severely affected adult cardiac surgery, increasing patient risk and adverse outcomes.
- A need exists for strategic planning to improve outcomes and reduce mortality/morbidity.
- Postponed operations and resource reallocation require careful consideration during pandemics.
Background:
The coronavirus disease 2019 (COVID-19) outbreak had a direct impact on adult cardiac surgery activity, which systematically necessitates a postoperative stay in intensive care.
Aim:
To study the effect of the COVID-19 lockdown on cardiac surgery activity and outcomes, by making a comparison with the corresponding period in 2019.
Methods:
This prospective observational cohort study compared adult cardiac surgery activity in our high-volume referral university hospital from 9 March to 10 May 2020 versus 9 March to 10 May 2019. Data were collected in our local certified database and a national database sponsored by the French society of thoracic and cardiovascular surgery. The primary study endpoints were operative mortality and postoperative complications.
Results:
With 105 interventions in 2020, our activity dropped by 57% compared with the same period in 2019. Patients were at higher risk, with a significantly higher EuroSCORE II score (3.8±4.5% vs. 2.0±1.8%; P<0.001) and higher rates of active endocarditis (7.6% vs. 2.9%; P=0.047) and recent myocardial infarction (9.5% vs. 0%; P<0.001). The weight and priority of the interventions were significantly different in 2020 (P=0.019 and P<0.001, respectively). The rate of acute aortic syndromes was also significantly higher in 2020 (P<0.001). Operative mortality was higher during the lockdown period (5.7% vs. 1.7%; P=0.038). The postoperative course was more complicated in 2020, with more postoperative bleeding (P=0.003), mechanical circulatory support (P=0.032) and prolonged mechanical ventilation (P=0.005). Only two patients (1.8%) developed a positive status for severe acute respiratory syndrome coronavirus 2 after discharge.
Conclusions:
Adult cardiac surgery was heavily affected by the COVID-19 lockdown. A further modulation plan is necessary to improve outcomes and reduce postponed operations to decrease operative mortality and morbidity.
