The Impact of COVID-19 Pandemic on Cardiac Surgery in Israel

Abstract

Background: Ever since the coronavirus disease 2019 (COVID-19) has become a pandemic, worldwide efforts are being made to “flatten the curve”. Israel was amongst the first countries to impose significant restrictions. As a result, cardiac surgeons have been required to scale down their routine practice, resulting in a significant reduction in the number of cardiac surgeries. The aim of this study is to characterize the impact of COVID-19 on cardiac surgery in Israel. Methods: This is a retrospective observational study performed in two cardiac surgery departments in Israel and includes all patients who underwent cardiac surgery in March and April during the years 2019 and 2020. The patient cohort was divided into two groups based on the year of operation. Analysis of the patients’ baseline characteristics, operative data, and postoperative outcome, was performed. Results: The 2019 group (n=173), and the 2020 group (n=108) were similar regarding their baseline characteristics, previous medical history, and rates of previous revascularization interventions. However, compared to the 2019 group, patients in the 2020 group were found to be more symptomatic (NYHA class IV; 2.4% vs. 6.2%, p=0.007). While all patients underwent similar procedures, patients in the 2020 group had significantly longer procedural time (p<0.001). In-hospital mortality rate was found to be significantly higher in group 2020 (13% vs. 5.2%, p=0.037). Conclusions: While the number of patients undergoing cardiac surgery declined during the outbreak period, the rate of surgical mortality increased. One explanation for this might be delayed hospital arrival.

The effect of the Covid-19 pandemic on patient visits to the emergency department and hospitalizations in medical wards in an Israeli medical center

“…2 Internal Medicine Wing, Sheba Medical Center, Tel Hashomer, Israel Affiliated To Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. 3 Israel Defense Forces, Israel Medical Corps, Ramat Gan, Israel.…”

“…In Israel, there was a significant decline in the visits to the emergency department (ED) during the first wave of the Covid-19 outbreak [2]. Hospital occupancies decreased and the number of elective procedures including cardiac surgeries declined [1][2][3]. Mendlovic et al showed a decrease in the number of patients visiting the ED and in the number of admissions to medical wards during the outbreak.…”

Prognostic value of SARS‐CoV‐2 on patients undergoing cardiac surgery

“…Indeed, due to the initial severe gap of knowledge (unknown level of virus penetration, scarcity of swab test and PPE, unclear healthcare protection protocols) therapeutic approach for cardiac urgencies was less than empirical, with uncertain organization and dismal outcomes. At nearly one year from COVID outbreak, few data (almost only case/centers experience) have been published so far on the impact of COVID‐19 on surgically treated patients 15,16 . However, the impact of health system rearrangement, human and physical resources allocation, and viremia‐related thromboembolic and respiratory burden on complex surgical outcomes is mandatory for safe surgical activity restart.…”

“…14 F I G U R E 1 ROC curve: predictivity of age for higher in-hospital mortality; AUC, area under curve; confidence limits are plotted (blue area); ROC, receiver operating characteristic (almost only case/centers experience) have been published so far on the impact of COVID-19 on surgically treated patients. 15,16 However, the impact of health system rearrangement, human and physical resources allocation, and viremia-related thromboembolic and respiratory burden on complex surgical outcomes is mandatory for safe surgical activity restart.…”

Lockdown surgery: the impact of coronavirus disease 2019 measures on cardiac cases

“…To contain the spread of the virus and ease the burden on hospitals, strict measures unprecedented in modern times were imposed. Entire nations have been placed under lockdown, schools and businesses closed and travel was restricted [ 5 , 6 ]. In Austria, these measures against COVID-19 became obligatory on 16 March 2020.…”