Impact of early Coronavirus Disease 2019 pandemic on pediatric cardiac surgery in China

Abstract

Objective This study aimed to provide an insight into the impact of early outbreak of the novel coronavirus disease 2019 (COVID-19) on the care management for patients with congenital heart disease. Methods This study respectively enrolled a cohort of surgical patients (patients undergoing surgery in 2018 [group I], 2019[group II], and 2020 [group III]) and a cohort of follow-up patients (patients having follow-up in 2017 [group A], 2018 [group B] and 2019 [group C]) from 13 children hospitals. Results During the COVID-19 era, there was a significant decrease in total surgical volume and a change in case mix in terms of an increase in the proportion of emergency operations. Decrease in migration scale index was correlated to the decrease in both surgical volume (r=0.64, p=0.02) and outpatient visit volume (r=0.61, p=0.03). There was a significantly higher proportion of patients who had follow-up through the internet or phone in group C (26.4% vs. 9.6% in group B and 8.9% in group A; p< 0.0001). There was no statistical difference in death or rehospitalization among the 3 follow-up groups (p=0.49). There was higher parents’ anxiety score (p < 0.0001) and more utilization of telemedicine (p = 0.004) in group C comparing to group A and B. Conclusion The COVID-19 pandemic has resulted in a considerable decrease in total surgical volume and a change of case mix, which seems to be related to the strict traffic ban. Follow-up through the online medical service appears to be an effective alternative to the conventional method.

The Current Landscape of Congenital Heart Surgery in Northern China: A Geographic and Population-Based Analysis

“…The importance of geographic barriers is demonstrated by a multicenter study from the United States, which found that the location of heart centers is a strong predictor of gaps in receiving cardiac care among adult CHD patients (27). Under some unusual scenarios, such as the recent outbreak of COVID-19 in China and other countries around the world, the operation of surgical programs for CHD could be severely affected (28). These patients have specialized healthcare needs and may have greater difficulties to receive care due to geographic barriers.…”

Impact of COVID-19 pandemic on pediatric cardiac services in India

“…A similar quantum of reduction in cardiac surgery has been reported from other parts of the world as well. Early reports from Italy,[ 8 ] China,[ 10 ] and Turkey[ 15 ] reported nearly half to two-third reduction in congenital cardiac surgeries during the pandemic as compared to the preceding year. In a global survey,[ 9 ] half of the interviewed participants reported >50% reduction in volume of CHD surgeries in their centers.…”

“…The postoperative mortality in our study was significantly higher in 2020 as compared to 2019. Studies from Italy[ 8 ] and China[ 10 ] do not report excess postoperative mortality during the pandemic. In contrast, a small study from Turkey[ 15 ] reported 13.8% mortality among children undergoing cardiac surgery on an emergency basis during the pandemic.…”

“…Data about the disruption caused by the pandemic on pediatric cardiac admissions are scarce and most of the published studies have focused only on neonatal and infantile pediatric cardiac surgeries. [ 8 9 ] The number of surgeries reportedly reduced by 52% in Italy and 8%–75% in China[ 10 ] during the early waves of the pandemic. A single tertiary care center from North India reported two-thirds reduction in admissions related to CHD.…”

Fostering a sustainable pediatric cardiac workforce in the developing world during the current COVID-19 pandemic

“…The present COVID-19 pandemic is a "black swan" event, an once-in-a-lifetime scenario causing major healthcare disruption. This pandemic has affected all health care services, and has complicated the care of CHD in many countries (9,10). The pandemic has triggered an alarm in emergency preparedness and immunization services (11).…”