Abstract
BackgroundEarly studies conclude patients with Covid-19 have a high risk of death, but no studies specifically explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid-19 pandemic.MethodsThis retrospective observational study included all adult patients undergoing cardiac surgery between 1st March and 30th April 2020 in nine UK centres. Data was obtained and linked locally from the National Institute for Cardiovascular Outcomes Research Adult Cardiac Surgery database, the Intensive Care National Audit and Research Centre database and local electronic systems. The anonymised datasets were analysed by the lead centre. Statistical analysis included descriptive statistics, propensity score matching (PSM), conditional logistic regression and hierarchical quantile regression.ResultsOf 755 included individuals, 53 (7.0%) had Covid-19. Comparing those with and without Covid-19, those with Covid-19 had increased mortality (24.5% v 3.5%, p < 0.0001) and longer post-operative stay (11 days v 6 days, p = 0.001), both of which remained significant after PSM. Patients with a pre-operative Covid-19 diagnosis recovered in a similar way to non-Covid-19 patients. However, those with a post-operative Covid-19 diagnosis remained in hospital for an additional 5 days (12 days v 7 days, p = 0.024) and had a considerably higher mortality rate compared to those with a pre-operative diagnosis (37.1% v 0.0%, p = 0.005).ConclusionsTo mitigate against the risks of Covid-19, particularly the post-operative burden, robust and effective pre-surgery diagnosis protocols alongside effective strategies to maintain a Covid-19 free environment are needed. Dedicated cardiac surgery hubs could be valuable in achieving safe and continual delivery of cardiac surgery.
Highlights
Studies conclude patients with Covid-19 have a high risk of death, but no studies explore cardiac surgery outcome
Preoperatively diagnosed patients appeared to recover from surgery in a similar manner to non-Covid-19 patients and the burden of Covid-19 appears to impact those diagnosed after surgery
Our study, thought to be the largest cohort study exploring cardiac surgery outcomes during a pandemic, identified that patients with Covid-19 had more than five times greater odds of dying than those without Covid19
Summary
Studies conclude patients with Covid-19 have a high risk of death, but no studies explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid pandemic. Cardiothoracic practice may not be in the frontline of the Coronavirus response but the service must respond to the demands of the pandemic, and in doing so has been considerably affected. In England, all National Health Service (NHS) hospitals were told by NHS England’s Chief Executive to suspend all elective surgery from 15th April for at least 3 months [5], many cardiothoracic centres, especially those in London, did so from mid-March. The best local solution to continue the proper management of urgent and emergency, patients while protecting resources for the response to Coronavirus, was needed [6]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have