Cardiac surgery outcome during the COVID-19 pandemic: a retrospective review of the early experience in nine UK centres

Abstract

Background Early 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. Methods This 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. Results Of 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). Conclusions To 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.

The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience

“…As a result, none of our patients contracted the disease over the investigated period, underlining the effectiveness of this protocol. This has important clinical implications as signified by a recent study including nine United Kingdom (UK)-based cardiac surgery centres, where COVID-19 diagnosis was independently associated with a 21% increase of in-hospital mortality and a prolongation of median length of stay by 6 days [ 15 ].…”

“…A national-wide UK registry report revealed that mortality of surgical AVR performed during the first pandemic period was not compromised, despite the relative increase of urgent/emergent cases and the attendant increased risk [ 16 ]. However, COVID-19 per se exerted detrimental effects by way of a 21% increase in mortality and a significant prolongation of length of stay [ 15 ]. A US-based study that obtained data from the Society of Thoracic Surgery (STS) Adult Cardiac Surgery Database demonstrated a detrimental effect of the pandemic on surgical mortality.…”

“…These observations were attributed to patients presenting at more advanced disease states leading to an augmented non-elective operations relative frequency with an attendant increase in surgical risk. Our unit managed to preserve the pre-COVID-19 surge mortality and major post-operative complications rate despite the significantly increased risk; the efficiency of our COVID-19 screening protocol appears to have contributed significantly in the light of the above-mentioned study findings [ 15 ].…”

Open Hart Surgery Experience of a High Volume Center During Pandemic

“…A recent large global cohort (7.6%) of elective and emergency patients with cardiac surgery was diagnosed postoperatively (18) . Theoretically, surgery can affect the immune system, accelerating the progression of Covid-19 through the immune response (19) , so that patients with incubation of Covid-19 before surgery may exacerbate the covid processes after surgery (20).…”

Cardiac Surgery in Australia During the COVID-19 Global Pandemic

“…The COVIDSurg Collaborative, reported 20.8% mortality in 207 COVID-19 positive patients from 13 countries [ 18 ] operated on between March and June, 2020. In a retrospective propensity matched cohort from a similar time frame, an increased mortality persisted, and the mortality associated with a postoperative COVID-19 diagnosis was significantly higher than that in patients operated after suffering COVID-19 preoperatively [ 19 ].…”