The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717,103 Patients

Abstract

Background: COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide at the time of publication. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on a national level.Methods: The STS Adult Cardiac Surgery Database was queried and analyzed from January 1, 2018 to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020 to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze mortality for all risk-adjustable cardiac procedures.Findings: A total of 717,103 adult cardiac surgery patients and more than 20 million COVID-19 patients were included for analysis. The South Atlantic (21.1%) and Great Lakes (17.4%) regions contributed the most patients during the study period. Nationally, there was a 52.7% reduction in overall adult cardiac surgery volume, and a 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with a 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes increased but did not return to baseline, indicating a COVID-associated deficit of cardiac surgery patients.Interpretation: This study is the largest analysis of COVID-19 related impact on adult cardiac surgery volume, trends, and outcomes. During the COVID-19 pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first surge of COVID-19 cases, with a concurrent significant increase in observed-to-expected 30-day mortality. Funding: None.Conflict of Interest: TCN – Consultant, Edwards LifeSciences, Abbott, LivaNova, CryoLife. VHT – Consultant/research, Abbott, Boston Scientific, Edwards LifeSciences, W. L. Gore & Associates, Jenavalve. APN – None. RHH – None. JAD – None. JAC – None. AR – None. HM – None.DMS – None. JPJ – None. VB – Consultant, Abbott.