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Cardiac Surgery During and After the Pandemic: A Retrospective Analysis of UK Trends and Outcomes
Tim Dong1, Norman Briffa2, Pradeep Narayan3
1Bristol Heart Institute, Bristol University, Bristol, BS2 8HW, United Kingdom.
Insights
The COVID-19 pandemic significantly disrupted adult cardiac surgery in the UK, impacting case mix, volume, and increasing mortality. Services have not yet recovered to pre-pandemic levels, highlighting ongoing challenges for this critical healthcare sector.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic profoundly affected healthcare systems globally.
- The specific impact on cardiac surgical services in the UK across different pandemic phases remains unclear.
Purpose of the Study:
- To assess the disruption and recovery of adult cardiac surgical care in the UK during the COVID-19 pandemic.
- To evaluate changes in surgical practice, clinical outcomes, and readmissions.
Main Methods:
- Analysis of cardiac surgical data across distinct pandemic periods: pre-lockdown, lockdowns, relaxations, and recovery.
- Evaluation of surgical case mix, volume, 30-day mortality, mid-term mortality, and waiting times.
Main Results:
- Coronary artery bypass grafts and aortic valve replacements were most frequent; urgent/emergency cases increased.
- A significant rise in 30-day mortality was observed post-pandemic, with higher mid-term mortality for later surgeries.
- Surgical volumes declined initially but showed gradual recovery, though not to pre-pandemic levels.
Conclusions:
- COVID-19 negatively impacted adult cardiac surgical case mix and volume in the UK.
- Cardiac surgical services have not fully recovered to pre-pandemic operational levels.
- Findings offer critical insights for policymakers and healthcare providers managing healthcare during crises.
Objectives:
The full extent of the COVID-19 pandemic's impact during different phases of the pandemic and the recovery of cardiac surgical services in the United Kingdom have not been comprehensively assessed. This study aims to evaluate these disruptions' impact and immediate recovery on delivering adult cardiac surgical care in the United Kingdom.
Methods:
The periods investigated were divided into pre-lockdown, first lockdown, first relaxation, second lockdown, second relaxation, third lockdown, and post-lockdown (recovery). Changes in surgical practice, early and mid-term clinical outcomes, and hospital readmission were analysed using various metrics across different time periods.
Results:
Coronary artery bypass grafts were the most performed procedure across all time periods, with the average number of urgent and emergency increasing compared to the pre-pandemic period. Aortic valve replacement was the next most frequent, followed by combined aortic valve and coronary artery bypass surgery. However, those procedures remained predominantly elective across all periods. There was a significant change in 30-day mortality rates across the pandemic phases (P < .001), with higher mortality observed post-pandemic. There was a gradual increase in the waiting times for elective and urgent surgeries from January 2018 to March 2022. Patients who had surgery before March 2020 had a significantly lower hazard of mid-term mortality than those who were operated on after this period (HR, 0.638; 95% CI, 0.5875-0.6921). All procedures showed gradual recovery across the pandemic periods following an initial decline at the beginning of the pandemic.
Conclusions:
COVID-19 had a significant negative impact on adult cardiac surgical case mix and volume and has not recovered to the pre-pandemic levels. This work, we believe, is important for policymakers, healthcare providers, and patients, as it offers insights into the challenges faced by a critical healthcare sector during a global crisis and highlights potential avenues for improvement.
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