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Changes in Practice/Outcomes of Pediatric/Congenital Catheterization in Response to the First Wave of COVID
Brian Quinn1, Oliver M Barry2, Sarosh P Batlivala3
1Department of Cardiology, Boston Children's Hospital and Department of Pediatrics Harvard Medical School, Boston, Massachusetts, USA.
Insights
The COVID-19 pandemic reduced pediatric cardiac catheterization volumes but did not increase adverse events. Congenital catheterization programs maintained performance despite increased case complexity during the pandemic.
Area of Science:
- Cardiology
- Pediatric Medicine
- Public Health
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- The effects of the pandemic on pediatric/congenital cardiac catheterization programs remain underdescribed.
Purpose of the Study:
- To assess changes in case volumes, patient risk profiles, and procedural outcomes in pediatric/congenital catheterization during and after the initial COVID-19 wave.
- To understand the impact of the pandemic on the practice and performance of these specialized cardiac procedures.
Main Methods:
- A multicenter retrospective observational study using Congenital Cardiac Catheterization Project on Outcomes (C3PO) Registry data.
- Comparison of procedural data from before, during, and after the first COVID-19 wave (March-May 2020).
- Analysis included case volume, case mix, high-severity adverse events (HSAEs), and multivariable risk adjustment.
Main Results:
- Center case volumes decreased significantly during the first COVID-19 wave.
- The proportion of complex cases, including infants, neonates, and those with renal insufficiency or recent cardiac surgery, increased.
- Despite increased complexity, the risk of high-severity adverse events (HSAEs) did not significantly change.
Conclusions:
- Pediatric/congenital catheterization programs maintained procedural safety and performance during the COVID-19 pandemic, even with increased case complexity.
- Findings suggest that adaptive practice changes may have mitigated risks, offering insights for future harm reduction.
Background:
The COVID-19 pandemic has posed tremendous stress on the health care system. Its effects on pediatric/congenital catheterization program practice and performance have not been described.
Objectives:
The purpose of this study was to evaluate how case volumes, risk-profile, and outcomes of pediatric/congenital catheterization procedures changed in response to the first wave of COVID-19 and after that wave.
Methods:
A multicenter retrospective observational study was performed using Congenital Cardiac Catheterization Project on Outcomes Registry (C3PO) data to study changes in volume, case mix, and outcomes (high-severity adverse events [HSAEs]) during the first wave of COVID (March 1, 2020, to May 31, 2020) in comparison to the period prior to (January 1, 2019, to February 28, 2020) and after (June 1, 2020, to December 31, 2020) the first wave. Multivariable analyses adjusting for case type, hemodynamic vulnerability, and age group were performed. Hospital responses to the first wave were captured with an electronic study instrument.
Results:
During the study period, 12,557 cases were performed at 14 C3PO hospitals (with 8% performed during the first wave of COVID and 32% in the postperiod). Center case volumes decreased from a median 32.1 cases/month (IQR: 20.7-49.0 cases/month) before COVID to 22 cases/month (IQR: 13-31 cases/month) during the first wave (P = 0.001). The proportion of cases with risk factors for HSAE increased during the first wave, specifically proportions of infants and neonates (P < 0.001) and subjects with renal insufficiency (P = 0.02), recent cardiac surgery (P < 0.001), and a higher hemodynamic vulnerability score (P = 0.02). The observed HSAE risk did not change significantly (P = 0.13). In multivariable analyses, odds of HSAE during the first wave of COVID (odds ratio: 0.75) appeared to be lower than that before COVID, but the difference was not significant (P = 0.09).
Conclusions:
Despite increased case-mix complexity, C3PO programs maintained, if not improved, their performance in terms of HSAE. Exploratory analyses of practice changes may inform future harm-reduction efforts.
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