CHICAGO (January 30, 2021) – The deadliest global health crisis in a century has led to a sharp decline in total heart surgery volume and a vague increase in deaths after coronary artery bypass grafting, according to a recent study at the 57th Annual General Meeting of the Society of Thoracic Surgeons.
“This study was a true herculean and tour de force analysis that demonstrated the impact of COVID on adult heart surgery size, movements, and outcomes,” said Tom C. Nguyen, MD, of the University of California San Francisco. “The pandemic has changed the world as we know it, causing a sharp drop in the volume of adult heart surgery and reducing patient outcomes.”
Dr. Nguyen and colleagues queried the STS Adult Cardiac Surgery Database from January 1, 2018, to June 30, 2020, and the Johns Hopkins COVID-19 Dashboard from February 1, 2020, to January 1, 2021. The researchers examined data from 717,103 adult heart surgery patients and more than 20 million COVID-19 patients in an effort to determine the impact of the whole disease on adult heart surgery at national levels and regional.
“Only the STS National Database has the granularity level, COVID variables, and continuous follow-up to answer the questions raised in this important study,” Dr. Nguyen said. “Our research analyzed data by department to get an idea of how specific domains performed during COVID pandemic.”
According to the results of the study, there was a 53% nationwide reduction in all adult heart card surgery measurements compared to 2019 and 65% fewer selected cases in the United States. COVID also affected non-elective cases, resulting in a 40% reduction.
In addition, the data showed no matter what the procedure – peripheral coronary artery bypass grafting (CABG), peripheral aortic valve replacement (AVR), peripheral mitral valve resection (MVR), CABG + AVR, CABG + MVR, remote MV repair, and CABG + MV repair – there was a significant decline in case volume – 54% – compared to 2019.
Regionally, the Mid-Atlantic region (New York, New Jersey, and Pennsylvania), was among those most affected by the COVID crisis, with a 71% reduction in overall case volume, 75% less than selected cases, and a 59% reduction in non-elective cases. Another hot spot, the New England region (Maine, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island) showed a 63% reduction in overall case volume.
The researchers also found that, prior to the rise of COVID, the Mid-Atlantic and New England regions had excellent results with an expected-to-expectation (O / E) ratio of less than 1, which is ‘represents a better-than-expected mortality rate. . However, during the COVID increase, there was a 110% increase in O / E for all adult heart procedures and a 167% increase for isolated CABG, resulting in more patients dying than expected.
Although the data did not directly address the cause of increased mortality, many surgeons say they are currently limited to working on only the most urgent coronary bypass cases and patients who tend to be more ill. . “These numbers should not be a deterrent to patients seeking care for breast pain or other heart symptoms,” said Robbin G. Cohen, MD, MMM, of the Keck School of Medicine at the University of Southern California at Los Angeles, which was not directly involved in this study. “If anything, they are a warning to get into the system as soon as possible.”
At the time of the show, there were 95.4 million global cases of COVID-19 with over 2 million global deaths. The U.S. accounted for more than 24 million cases and about 400,000 deaths.
In the past year, this crisis has changed or halted almost every aspect of society, and it is clear that the practice of cardiothoracic surgery has not been immune. Sudden cessation of surgery in mid-March 2020 has been shown to have a significant impact, as the negative effects of delayed and delayed procedures on patient health outcomes are now being realized.
“We have clearly shown that if you have heart surgery during COVID, you have a higher risk of morbidity and mortality,” Dr. Nguyen said. “Without a doubt COVID hit us hard.”
According to Dr Nguyen, this study is just the first of many more “granular” studies to come. The researchers plan to study the trends and outcomes of COVID patients vs non-COVID patients, as well as further study into the impact of COVID on specific adult heart procedures such as aortic disorders.
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Founded in 1964, the Society of Thoracic Surgeons is a non-profit organization representing more than 7,500 cardiothoracic surgeons, researchers, and allied health care professionals worldwide dedicated to ensuring the optimal results for surgeries of the heart, lungs, and esophagus, as well as other surgical procedures within the breast. The mission of the Society is to advance the delivery of cardiothoracic surgeons of the highest quality patient care through collaboration, education, research and advocacy.
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