‘COVID effect’ leads to fewer cardiac surgeries, more deaths

Editor's Note

The COVID-19 pandemic has resulted in a substantial decline in cardiac surgery volume and an unexplained increase in deaths after coronary artery bypass grafting (CABG), finds this study presented January 30 at the Annual Meeting of the Society of Thoracic Surgeons (STS).

Researchers from the University of California, San Francisco, examined 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, which included data on 717,103 adult cardiac surgery patients and more than 20 million COVID-19 patients.

Results showed a 53% decrease nationwide in adult cardiac surgery volume, compared to 2019, with 65% fewer elective cases and a 40% decrease in nonelective cases. Regionally, the Mid-Atlantic area was among the most affected with a 71% decrease in overall case volume, and the New England region had a 63% reduction.

Before the COVID-19 surge, the Mid-Atlantic and New England regions had excellent outcomes with an observed-to-expected (O/E) ratio of less than 1. However, during the COVID-19 surge, there was a 110% increase in the O/E for all adult cardiac procedures and a 167% increase for CABG, which means more patients were dying than expected.

The data do not directly address the cause of increased mortality, but many surgeons say they are limited to operating only on the most urgent CABG cases and patients who tend to be sicker.

The abrupt cessation of surgery in mid-March 2020 has proven to have had far-reaching implications, as the negative effects on patient outcomes are not being realized, the researchers say.