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Effect of COVID-19 on cardiac surgery volumes in Sweden
Torbjörn Ivert1,2, Magnus Dalén1,2, Örjan Friberg3
1Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Insights
The COVID-19 pandemic reduced cardiac surgery volumes by 9.4% in Sweden in 2020, with a partial recovery in 2021. Despite longer wait times, patient outcomes and early mortality remained stable, with no surgical backlog.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally, leading to disruptions in non-emergency medical services.
- Cardiac surgery, a critical component of cardiovascular care, may have been affected by pandemic-related resource allocation and patient-related factors.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on cardiac surgery volumes in Sweden.
- To evaluate changes in patient demographics, surgical urgency, and outcomes during the pandemic.
Main Methods:
- A retrospective nationwide observational study was conducted using data from Swedish cardiac surgery centers.
- Surgical volumes, patient characteristics, waiting times, and early mortality were compared between 2019, 2020, and 2021.
Main Results:
- Cardiac surgery volumes decreased by 9.4% in 2020 compared to 2019, with a 5.8% increase in 2021. Waiting times increased in 2020.
- Patients undergoing surgery in 2020 were younger with better renal function but had more comorbidities like diabetes and hypertension.
- Despite changes in patient profiles and procedure urgency, early mortality and postoperative complications remained low and consistent across the study period.
Conclusions:
- The COVID-19 pandemic led to a significant, though partially reversible, reduction in Swedish cardiac surgery volumes.
- The study found no evidence of a surgical backlog, indicating efficient management of patient flow despite pandemic challenges.
- Patient characteristics shifted during the pandemic, highlighting the need for adaptive strategies in cardiac surgery care delivery.
Abstract:
Objectives. The coronavirus disease 2019 (COVID-19) pandemic, which commenced in 2020, is known to frequently cause respiratory failure requiring intensive care, with occasional fatal outcomes. In this study, we aimed to conduct a retrospective nationwide observational study on the influence of the pandemic on cardiac surgery volumes in Sweden. Results. In 2020, 9.4% (n = 539) fewer patients underwent open-heart operations in Sweden (n = 5169) than during 2019 (n = 5708), followed by a 5.8% (n = 302) increase during 2021 (n = 5471). The reduction was greater than 15% in three of the eight hospitals in Sweden performing open-heart operations. Compared to 2019, in 2020, the waiting times for surgery were longer, and the patients were slightly younger, had better renal function, and a lower European System for Cardiac Operative Risk Evaluation; moreover, few patients had a history of myocardial infarction. However, more patients had insulin-treated diabetes mellitus, hypertension, peripheral vascular disease, reduced left ventricular function, and elevated pulmonary artery pressure. Urgent procedures were more common, but acute surgery was less common in 2020 than in 2019. Early mortality and postoperative complications were low and did not differ during the three years. Conclusion. The 9.4% decrease in the number of heart surgeries performed in Sweden during the 2020 COVID-19 pandemic, compared to 2019, partially recovered during 2021; however, there was no backlog of patients awaiting heart surgery.
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