Julie Sanders1,2, Enoch Akowuah3, Jackie Cooper4, Bilal H Kirmani5, Mazyar Kanani3, Metesh Acharya6, Reuben Jeganathan7, George Krasopoulos8, Dumbor Ngaage9, Indu Deglurkar10, Patrick Yiu11, Simon Kendall3, Aung Ye Oo12,4. 1. St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK. j.sanders@qmul.ac.uk. 2. William Harvey Research Institute, Queen Mary University of London, London, UK. j.sanders@qmul.ac.uk. 3. Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK. 4. William Harvey Research Institute, Queen Mary University of London, London, UK. 5. Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. 6. Department of Cardiothoracic Surgery, Glenfield Hospital, University Hospitals Leicester NHS Foundation Trust, Leicester, UK. 7. Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK. 8. Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 9. Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK. 10. Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, Wales, UK. 11. Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK. 12. St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK.
Abstract
BACKGROUND: Early studies conclude patients with Covid-19 have a high risk of death, but no studies specifically explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid-19 pandemic. METHODS: This retrospective observational study included all adult patients undergoing cardiac surgery between 1st March and 30th April 2020 in nine UK centres. Data was obtained and linked locally from the National Institute for Cardiovascular Outcomes Research Adult Cardiac Surgery database, the Intensive Care National Audit and Research Centre database and local electronic systems. The anonymised datasets were analysed by the lead centre. Statistical analysis included descriptive statistics, propensity score matching (PSM), conditional logistic regression and hierarchical quantile regression. RESULTS: Of 755 included individuals, 53 (7.0%) had Covid-19. Comparing those with and without Covid-19, those with Covid-19 had increased mortality (24.5% v 3.5%, p < 0.0001) and longer post-operative stay (11 days v 6 days, p = 0.001), both of which remained significant after PSM. Patients with a pre-operative Covid-19 diagnosis recovered in a similar way to non-Covid-19 patients. However, those with a post-operative Covid-19 diagnosis remained in hospital for an additional 5 days (12 days v 7 days, p = 0.024) and had a considerably higher mortality rate compared to those with a pre-operative diagnosis (37.1% v 0.0%, p = 0.005). CONCLUSIONS: To mitigate against the risks of Covid-19, particularly the post-operative burden, robust and effective pre-surgery diagnosis protocols alongside effective strategies to maintain a Covid-19 free environment are needed. Dedicated cardiac surgery hubs could be valuable in achieving safe and continual delivery of cardiac surgery.
BACKGROUND: Early studies conclude patients with Covid-19 have a high risk of death, but no studies specifically explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid-19 pandemic. METHODS: This retrospective observational study included all adult patients undergoing cardiac surgery between 1st March and 30th April 2020 in nine UK centres. Data was obtained and linked locally from the National Institute for Cardiovascular Outcomes Research Adult Cardiac Surgery database, the Intensive Care National Audit and Research Centre database and local electronic systems. The anonymised datasets were analysed by the lead centre. Statistical analysis included descriptive statistics, propensity score matching (PSM), conditional logistic regression and hierarchical quantile regression. RESULTS: Of 755 included individuals, 53 (7.0%) had Covid-19. Comparing those with and without Covid-19, those with Covid-19 had increased mortality (24.5% v 3.5%, p < 0.0001) and longer post-operative stay (11 days v 6 days, p = 0.001), both of which remained significant after PSM. Patients with a pre-operative Covid-19 diagnosis recovered in a similar way to non-Covid-19patients. However, those with a post-operative Covid-19 diagnosis remained in hospital for an additional 5 days (12 days v 7 days, p = 0.024) and had a considerably higher mortality rate compared to those with a pre-operative diagnosis (37.1% v 0.0%, p = 0.005). CONCLUSIONS: To mitigate against the risks of Covid-19, particularly the post-operative burden, robust and effective pre-surgery diagnosis protocols alongside effective strategies to maintain a Covid-19 free environment are needed. Dedicated cardiac surgery hubs could be valuable in achieving safe and continual delivery of cardiac surgery.
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