Surgical Case Volume Research Articles

STS Adult Cardiac Surgery Database: 2021 Update on Outcomes, Quality, and Research

The Society of Thoracic Surgeons Adult Cardiac Surgery Database is the most mature and comprehensive cardiac surgery database. It has been the foundation for quality measurement and improvement activities in cardiac surgery, facilitated the generation of accurate risk adjusted performance benchmarks and serves as a platform for novel research. Recent enhancements have added to the database's functionality, ease of use, and value to multiple stakeholders. This report is the sixth in a series of annual reports that provide updated volumes, outcomes, database-related developments, quality improvement initiatives, and research summaries using the Adult Cardiac Surgery Database in the past year.

Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration.

Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration.

Simulation-optimization of automated material handling systems in a healthcare facility

Automated material handling systems are used in healthcare facilities to optimize material flow, minimize workforce requirements, reduce risk of contamination, and reduce work injuries. This paper develops a case study using data from Greenville Memorial Hospital (GMH) in South Carolina, USA. The case study is focused on the delivery of surgical case carts to operating rooms at GMH via Automated Guided Vehicles (AGVs). This study proposes a framework that integrates data analysis with system simulation and optimization. The study addresses the following research questions: (1) Redesign of the pathways: Do performance measures, such as travel time and task completion time, improve after a redesign of AGV pathways? (2) Operational fleet sizing: Do performance measures, such as travel time and task completion time, improve when the number of AGVs used daily is controlled by the volume of surgical cases? If this is true, then how many AGVs should be used daily? To address research question (1), we compare two AGV pathway designs via an extensive sensitivity analysis. To address research question (2), we use a simulation-optimization model to evaluate the performance of the system for different fleet sizes. Finally, we conduct a pilot study at GMH to validate the results of our analysis. This study indicates that the proposed solution, which uses a smaller fleet of AGVs than currently used at GMH, leads to significant reductions in congestion and travel times, and increased utilization of AGVs.

Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery.

Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier to addressing unmet need. We present a comprehensive national sample of surgical encounters from a LIC by assessing the National Health Services of Mozambique. A prospective cohort of all surgical encounters from Mozambique's National Health Service was gathered for all provinces between July and December 2015. Primary outcomes were timely access, provider densities for surgery, anesthesiology, and obstetrics (SAO) per 100,000 population, annualized surgical procedure volume per 100,000, and postoperative mortality (POMR). Secondary outcomes include operating room density and efficiency. Fifty-four hospitals had surgical capacity in 11 provinces with 47,189 surgeries. 44.9% of Mozambique's population lives in Districts without access to surgical services. National SAO density was 1.2/100,000, ranging from 0.4/100,000 in Manica Province to 9.8/100,000 in Maputo City. Annualized national surgical case volume was 367 procedures/100,000 population, ranging from 180/100,000 in Zambezia Province to 1,897/100,000 in Maputo City. National POMR was 0.74% and ranged from 0.23% in Maputo Province to 1.78% in Niassa Province. Surgical delivery in Mozambique falls short of international targets. Subnational deficiencies and variations between provinces pose targets for quality improvement in advancing national surgical plans. This serves as a template for LICs to follow in gathering surgical metrics for the WHO and the World Bank and offers short- and long-term targets for surgery as a component of health systems strengthening.

Analysis of the impact of the pandemic on surgical residency programs during the first wave in Argentina: A cross – sectional study

IntroductionCOVID – 19 emerged as a global pandemic in 2020 and affected the teaching methods at all levels. Surgical education has also been significantly affected by this pandemic, but the effect remains unknown. We developed a survey in order to obtain more information on how this pandemic affected the training and education of surgical residency programs. Material and methodsCross-sectional study. We surveyed 195 residents of various surgical programs, from August 20th to September 30th, 2020, in Córdoba, Argentina. The effect of the COVID – 19 pandemic was analyzed on surgical training, on the academic program, and professional burnout. ResultsThe volume of surgical cases performed during the pandemic decreased dramatically, affecting mainly residents of lower years. Comparing the number of cases (>7) that residents carried out per week (Pre pandemic vs pandemic), we found that PGY – 1: 47% vs 9%; p = 0.01 and PGY – 2: 46% vs 8%; p = 0.03. 83.2% reported that the impact of the pandemic affected their surgical training negatively and 45% were not adequately trained to carry out their surgical activity in the residency program. On the other hand, 71.3% affirmed that this health emergency allowed them to dedicate more time to the development of their academic training. ConclusionThis is the first cross – sectional survey study that shows the impact of the pandemic on surgical residences during the first wave in Argentina. Surgical training performed by residents had a negative impact.

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival.

ObjectivesTo investigate factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and to analyze its effect on short‐term and long‐term overall survival (OS).MethodsThe National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with laryngeal cancer, who received TL within 60 days of diagnosis, and who had an inpatient LOS ≥1 night. Multivariable binary logistic regression and survival analyses on propensity score matched cohorts with Kaplan‐Meier analysis and extended Cox regression were utilized.ResultsEight thousand two hundred and ninety‐eight patients from the NCDB were included. Median inpatient LOS was 8 days after TL (IQR: 7, 12). Prolonged LOS was defined as above the 75th percentile or 13 days or greater. On multivariable analysis, increasing patient age (OR 1.14 per 10 years, P = .003), female sex (OR 1.35, P < .001), and Charlson‐Deyo comorbidity score of ≥2 compared to a score of 0 (OR 1.43, P < .001) were associated with prolonged LOS. Patients treated at high surgical case volume centers had a decreased likelihood for prolonged LOS (OR 0.67, P < .001). Ninety‐day mortality increased over time in patients who stayed ≥13 days. Prolonged LOS was independently associated with worse OS on multivariable analysis (HR 1.40, 95% CI: 1.22, 1.61) in a matched cohort.ConclusionsProlonged LOS after TL serves as a strong indicator for postoperative long‐term mortality and may help identify patients who warrant closer surveillance.Level of Evidence3.

The Effect of COVID-19 on Training and Case Volume of Vascular Surgery Trainees.

Background:In many facilities, the coronavirus disease (COVID-19) pandemic caused suspension of elective surgery. We therefore sought to determine the impact of this on the surgical experience of vascular trainees.Methods:Surgical case volume, breadth, and the participating trainee post-graduate level from 3 large New York City Hospitals with integrated residency and fellowship programs (Mount Sinai, Montefiore Medical Center/Albert Einstein College of Medicine, and New York University) were reviewed. Procedures performed between February 26 to March 25, 2020 (pre-pandemic month) and March 26 to April 25, 2020 (peak pandemic period) were compared to those performed during the same time period in 2019. The trainees from these programs were also sent surveys to evaluate their subjective experience during this time.Results:The total number of cases during the month leading into the peak pandemic period was 635 cases in 2019 and 560 cases in 2020 (12% decrease). During the peak pandemic period, case volume decreased from 445 in 2019 to 114 in 2020 (74% reduction). The highest volume procedures during the peak pandemic month in 2020 were amputations and peripheral cases for acute limb ischemia; during the 2019 period, the most common cases were therapeutic endovascular procedures. There was a decrease in case volume for vascular senior residents of 77% and vascular junior and midlevel residents of 75%. There was a 77% survey response rate with 50% of respondents in the senior years of training. Overall, 20% of respondents expressed concern about completing ACGME requirements due to the COVID-19 pandemic.Conclusions:Vascular surgery-specific clinical educational and operative experiences during redeployment efforts have been limited. Further efforts should be directed to quantify the impact on training and to evaluate the efficacy of training supplements such as teleconferences and simulation.

Lessons Learned From an Anatomic Pathology Department in a Large Academic Medical Center at the Epicenter of COVID-19

Many state-wide, city-wide, and hospital-wide changes have been implemented due to the ongoing COVID-19 crisis. We describe lessons learned in an anatomic pathology division at a tertiary care center during the peak of the COVID-19 pandemic in the hopes that knowledge of our experiences can benefit other pathology departments as they encounter this pandemic. Five categories that are critical in strategic planning for the COVID-19 pandemic are discussed: workload, departmental policy revisions, impact on faculty, workforce staffing, and impact on educational programs, including residency and fellowship training. Although the volume of COVID-19 testing had grown placing increased demands on the clinical pathology laboratory, the volume of anatomic pathology cases had declined during the COVID-19 peak. Lessons learned were widespread including changes in the anatomic pathology workflow due to declining surgical and cytologic case volumes and increases in autopsy requests. Modifications were required in gross room policies, levels of personal protective equipment, and workforce. Travel and meeting policies were impacted. Adaptations to residency and fellowship programs were vast and included innovations in didactic and interactive education. We must learn from our experiences thus far in order to move forward, and we hope that our experiences in an anatomic pathology department in the epicenter of the COVID-19 pandemic can help other pathology departments across the country.

Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter.

ABSTRACTObjective Since the rising of coronavirus disease 2019 (COVID-19) pandemic, there is uncertainty regarding the impact of transmission to cancer patients. Evidence on increased severity for patients undergoing antineoplastic treatment is posed against deferring oncologic treatment. We aimed to evaluate the impact of COVID-19 pandemic on patient volumes in a cancer center in an epicenter of the pandemic.Methods Outpatient and inpatient volumes were extracted from electronic health record database. Two intervals were compared: pre-COVID-19 (March to May 2019) and COVID-19 pandemic (March to May 2020) periods.Results The total number of medical appointments declined by 45% in the COVID-19 period, including a 56.2% decrease in new visits. There was a 27.5% reduction in the number of patients undergoing intravenous systemic treatment and a 57.4% decline in initiation of new treatments. Conversely, there was an increase by 309% in new patients undergoing oral chemotherapy regimens and a 5.9% rise in new patients submitted to radiation therapy in the COVID-19 period. There was a 51.2% decline in length of stay and a 60% reduction in the volume of surgical cases during COVID-19. In the stem cell transplant unit, we observed a reduction by 36.5% in length of stay and a 62.5% drop in stem cell transplants.Conclusion A significant decrease in the number of patients undergoing cancer treatment was observed after COVID-19 pandemic. Although this may be partially overcome by alternative therapeutic options, avoiding timely health care due to fear of getting COVID-19 infection might impact on clinical outcomes. Our findings may help support immediate actions to mitigate this hypothesis.

COVD-13. EFFECTS OF COVID-19 PANDEMIC ON NEUROSURGICAL ONCOLOGY PRACTICES AT INOVA HEALTH SYSTEM: AN INSTITUTIONAL EXPERIENCE

INTRODUCTIONAmidst the unprecedented nationwide ban on elective surgeries during the COVID-19 pandemic, concern regarding timely and safe treatment of patients with intracranial tumors has been raised in the neuro-oncology community.METHODSA retrospective chart review was performed on all patients who underwent treatment for intracranial tumors from 3/12–7/1 for 2019 and 2020. Dates aligned with declaration of State of Emergency through the multi-phase public re-opening. Primary comparative endpoints included case volume, median time to surgery, chemotherapy, and radiation, and COVID-related mortality.RESULTSOverall surgical case volume decreased by 26.6%, while a 46.9% decrease was evident during the ban on elective surgeries. Case reduction occurred only for glial (p= 0.33) and pituitary tumors (p=0.04) where volume was nearly identical for other tumors. Median time to surgery was 2.5 days (range: 0–9) for high-grade glioma patients, 3 days for metastases, 3 days for meningiomas, and 26 days (range: 0–98) for pituitary adenomas, not significantly different from 2019. Time to chemoradiation and planned number of treatments were without significant difference. Among 2,795 Covid-19 patients treated in our institution, only four had brain tumors. Only one patient experienced delayed radiation treatment (three weeks) due to inability to achieve seroconversion prior to planned simulation. Only one COVID-related mortality in our cohort occurred.DISCUSSIONThe pandemic did not significantly delay type and time to treatment for neuro-oncology patients at Inova. With swift implementation of PPE and strict peri-operative testing, we provided standard of care treatment without increases in COVID-19 contraction or mortality. Decreases in overall case volume are likely due to ongoing cultural avoidance of seeking medical care; deferment of endonasal surgery may be attributed to a known greater mortality for ENT procedures. Future patient care challenges include establishing clinical significance of seroconversion for asymptomatic, COVID-19 infected patients without delaying necessary systemic treatment.

The Impact of the COVID-19 Pandemic on Obstetric and Gynecologic Procedures and Consults at a Metropolitan Hospital in the Epicenter

Study ObjectiveThe purpose of this study was to assess the impact of the COVID-19 pandemic on surgical volume and emergency department (ED) consults across obstetric & gynecologic (OB/GYN) services at a hospital located in the national epicenter of the pandemic.DesignRetrospective cohort study.SettingTertiary-care academic medical center in a metropolitan city.Patients or ParticipantsWomen undergoing OB/GYN ED consults or surgical procedures.InterventionsMarch 16th institutional COVID-19 mandate to hold all elective surgeries.Measurements and Main ResultsThe volume and types of surgical cases and ED consults were compared before and after the COVID-19 mandate. During the pandemic, the volume of ED consults and GYN surgeries significantly decreased, while OB surgeries remained stable. The average weekly case volume for ED consults, GYN surgeries, and OB surgeries were 44.8, 34.8, and 38.6 cases respectively during the “pre-COVID” timeframe (February 1st to March 15th) versus 17.8, 7.2, and 40.9 cases respectively during the “post-COVID” timeframe (March 16th toApril 15th), representing a 60.3% decrease in ED consults (p=<0.01) and a 79.3% decrease in GYN surgical volume (p=<0.01). The distribution of GYN surgical case types also changed significantly during the pandemic with higher proportions of emergent surgeries for ectopics, miscarriages, and concern for cancer (p <0.001). Alternatively, the OB surgical volume and distribution of OB surgical case types remained relatively constant.ConclusionThis study highlights how the pandemic has impacted the ways OB/GYN patients access and receive care. The OB surgeries remained stable during the COVID-19 pandemic reflecting the non-elective and time-sensitive nature of obstetric care. In contrast, ED consults and GYN surgeries decreased significantly. As expected, institutional policies suspending elective surgeries affected the volume and types of GYN surgeries performed during the pandemic, and the “stay-at-home” policy and personal fears of COVID-19 infection likely affected ED consult volumes.

Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs

ObjectiveTo determine the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on operative case volume in 8 U.S. neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period.MethodsA retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January through April 2020. Cases were grouped as elective cranial, elective spine, and nonelective emergent cases. Programs were surveyed regarding residents' perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data were analyzed for individual programs and pooled across programs.ResultsAcross programs, the 2019 monthly mean ± SD case volume was 211 ± 82; 2020 mean ± SD case volumes for January, February, March, and April were 228 ± 93, 214 ± 84, 180 ± 73, and 107 ± 45. Compared with 2019, March and April 2020 mean cases declined 15% (P = 0.003) and 49% (P = 0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents required COVID-19 testing; however, to our knowledge, only 1 resident from the participating programs tested positive.ConclusionsThis study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the COVID-19 pandemic on residents' operative case volumes, identify deficiencies, and develop plans to mitigate any effects.

Public Interest in Sports Medicine and Surgery (Anterior Cruciate Ligament, Meniscus, Rotator Cuff) Topics Declined Following the COVID-19 Outbreak

PurposeTo quantify the coronavirus disease 2019 (COVID-19) pandemic’s impact on public interest in sports medicine and surgery topics.MethodsThe Google Trends analysis tool (Google Search Volume Indices [GSVI]) was used to collect search information regarding orthopaedic sports medicine terms (“ACL,” “meniscus,” “rotator cuff”) and sports surgery terms (“ACL surgery,” “meniscus surgery,” “rotator cuff surgery”) from May 2015 to May 2020. A time series analysis was performed for these GSVIs and compared to the timing of the pandemic.ResultsInterest in both sports medicine and surgery declined following the COVID-19 outbreak. Following the World Health Organization’s statement on COVID-19’s pandemic status on March 11, 2020, searches for “ACL,” “meniscus” and “rotator cuff” declined by 34.78%, 43.95%, and 31.37%, and search for “ACL surgery,” “meniscus surgery” and “rotator cuff surgery” declined by 42.70%, 51.88%, and 53.32%, respectively.ConclusionThe COVID-19 outbreak correlated with a decline in public interest in sports medicine and sports surgery topics, as measured by Google searches.Clinical relevanceOrthopaedic sports medicine and arthroscopy patient and surgical case volumes were negatively affected by various factors after the onset of the pandemic. One factor associated with the volume decrease is a decline in public interest.

Impact of COVID-19 response on global surgical volumes: an ongoing observational study.

ObjectiveTo determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe collected data provided by users of the mobile app “Anesthesiologist” during 1 October 2018–30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions.FindingsA total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline.ConclusionApp data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need.

Association between surgical case volume and survival in T1 bladder cancer: A plea for regionalization of care?

Introduction: Prior research demonstrated an association between surgical case volume and survival in muscle-invasive bladder cancer (BC). This relationship, however, has not been investigated in the setting of T1 BC so far. Therefore, we investigated whether a higher surgical case volume of T1 BC translates into improved survival outcomes.&#x0D; Methods: Province-wide pathology reports (January 2002 to December 2015) were linked with health administrative data to identify patients diagnosed with T1 BC. For each patient, we determined the T1 case volume of the involved surgeon by benchmarking (percentile) her/him against his/her colleagues during a lookback period of one year. The volume-outcome (overall survival) relationship was then investigated by Cox proportional hazards regression (unadjusted and adjusted for a wide range of assumed confounders) that incorporated volume in three different ways (80th percentile and higher vs. below, median and higher vs. below, continuous [quintiles]). Effect sizes were presented as hazard ratios (95% confidence interval).&#x0D; Results: We identified 7426 patients who were diagnosed with T1 BC and followed for 4.8 years. A third of all patients (n=1895, 25.5%) received surgery by a high-volume surgeon (80th percentile and higher). Higher T1 case volume was associated with improved survival both in unadjusted (80th percentile: 0.93 [0.86–0.99]; median: 0.93 [0.87–0.99]; continuous: 0.97 [0.94–0.99]) and adjusted analysis (80th percentile: 0.94 [0.88–1.01]; median: 0.93 [0.87–0.99]; continuous: 0.97 [0.95–0.99]).&#x0D; Conclusions: This province-wide cohort study could demonstrate a volume-outcome relationship in T1 BC and raises questions regarding the regionalization of care in high-risk non-muscle-invasive BC. The generalizability of our findings, however, is limited by the fact that the performance of the initial resection by a high-volume surgeon does not necessarily translate into downstream care by the same surgeon.

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Abstract The COVID-19 pandemic has magnified the importance of delivering high-quality healthcare while preserving limited or depleted resources. This is particularly true in cardiac surgery, which depends on the same equipment, hospital capacity, and personnel that have been re-directed to COVID-19 care. Enhanced recovery programs promote standardized, consistent perioperative care, with an emphasis on incorporating evidence-based measures to optimize the patient experience, improve outcomes and utilize resources efficiently. Developing and implementing a program in the current COVID-19 environment is a daunting task. The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac), representing an international, multi-disciplinary group of experts, provides the rationale, supportive evidence, and a proposed outline for a sustainable modified program within the constraints of the COVID-19 pandemic. It is feasible to launch in the current healthcare climate and is designed to preserve resources, reduce case backlog, and protect patient and provider safety while improving patient care and preserving institutional quality metrics. The program can also create the foundation for future growth.

Current challenges in military trauma readiness: Insufficient relevant surgical case volumes in military treatment facilities.

The management of battlefield trauma requires a specific skill set, which is optimized by regular trauma experience. As military casualties from the prolonged conflicts in the Middle East decrease, challenges exist to maintain battlefield trauma readiness. Military surgeons must therefore depend on the Military Health System. The purpose of the study was to evaluate the frequency of surgical cases relevant to deployed combat casualty care performed at military treatment facilities (MTFs). Combat casualty care relevant cases (CCC-RCs) were defined as emergent, open surgical cases in which the patient required a blood transfusion. Case logs from four military treatment centers with surgical residency training programs were used. Twenty-four months of case records between January 1, 2017, and January 1, 2019, were included to determine total numbers of CCC-RCs at each institution. The results were compared with San Antonio Military Medical Center's, the Department of Defense's only American College of Surgeons-verified level 1 trauma center. Fifty-one trauma/general surgeons and six vascular surgeons case logs were examined. Thirty (0.3%) of 10,529 cases performed by trauma/general and vascular surgeons over the 2-year study period were considered CCC-RCs. These results were in contrast to San Antonio Military Medical Center, which had a significantly higher proportion of CCC-RCs (113 of 320 cases, 35.3%, p < 0.0001). A cross-section of MTF surgical case complexity demonstrates a lack of cases considered to be CCC-RCs. At the MTFs evaluated, surgical case surrogates for combat trauma and combat casualty care is close to zero. These data are potentially representative of other military treatment centers, which focus on beneficiary care. For readiness purposes, MTFs that care primarily for Tricare beneficiaries without a significant trauma population should not be considered meaningful sources of CCC-RCs for trauma/general and vascular surgeons. Therapeutic/care management study, level V.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

Cardiothoracic Surgical Volume Within the Military Health System: Fiscal Years 2007 to 2017

Cardiothoracic surgical services have been provided at 7 military treatment facilities over the past decade. Accurate case volume data for adult cardiac and general thoracic surgical service lines in the Military Health System is unknown. We queried the Military Health System Data Repository for adult cardiac and general thoracic cases performed at military treatment facilities in the Military Health System and surrounding purchased care markets for fiscal years 2007 to 2017. Cases were filtered and classified into major cardiac and major general thoracic categories. Five military treatment facility markets had sufficient cardiac case data to perform cost analysis. Institutional major cardiac case volume was low across the Military Health System with less than 100 cardiopulmonary bypass cases per year (range, 17-151 cases per year) performed most years at each military treatment facility. Similarly, general thoracic surgical case volume was universally low, with less than 30 anatomic lung resections (range, 0-26) and fewer than 5 esophageal resections (range, 0-4) performed at each military treatment facility annually. Cost analysis revealed that provision of cardiac surgical services is significantly more expensive at most military treatment facilities compared with their surrounding purchased care markets. Adult cardiac and general thoracic surgical volume within the Military Health System is low across all institutions and inadequate to provide clinical readiness for active-duty surgeons. Recapture of major cases from the purchased care market is unlikely and would not significantly increase military treatment facility or individual surgeon case volume.

Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. MethodsA survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. ResultsOur study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high –7.6% vs low –2.6%, P = .195). ConclusionsThe present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.