The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717,103 Patients

Nguyen, Tom C.; Thourani, Vinod H.; Nissen, Alexander P.; Habib, Robert H.; Dearani, Joseph A.; Ropski, Allan; Crestanello, Juan A.; Shahian, David M.; Jacobs, Jeffrey P.; Badhwar, Vinay

Background COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on regional and national levels. Methods The STS Adult Cardiac Surgery Database was queried from January 1, 2018 to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020 to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze risk-adjustable mortality. Results 717,103 adult cardiac surgery patients and over 20 million COVID-19 patients were analyzed. Nationally, there was 52.7% reduction in adult cardiac surgery volume, and 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes did not return to baseline, indicating a COVID-19-associated deficit of cardiac surgery patients. Conclusions This is the largest analysis of COVID-19 related impact on adult cardiac surgery volume, trends, and outcomes. During the pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first COVID-19 surge, with a concurrent increase in observed-to-expected 30-day mortality.