Impact of early Coronavirus Disease 2019 pandemic on pediatric cardiac surgery in China. Shi G, Huang J, Pi M, Chen X, Li X, Ding Y, Zhang H; National Association of Pediatric Cardiology and Cardiac Surgery Working Group. J Thorac Cardiovasc Surg. 2020 Dec 1:S0022-5223(20)33146-9. doi: 10.1016/j.jtcvs.2020.11.074. Online ahead of print. PMID: 33419537
Take Home Message:
- The COVID 19 pandemic has decreased overall congenital surgical volume.
- There is an increased proportion of emergent and urgent operations (change in case-mix).
- Travel restrictions may affect access to congenital cardiac surgical care.
Commentary from Dr. Luis Quinonez (Boston, MA, USA), section editor of Congenital Heart Surgery Journal Watch:
The objective of the study was to evaluate the impact of COVID-19 outbreak on the 1) congenital heart surgery programs and 2) the outcomes of patients with repaired lesions. This is a multicenter observational cohort study of 13 pediatric congenital heart disease surgical centers in China. The surgical cohort was divided into 3 groups: January to April 2018, 2019, and 2020 (COVID-19 era surgery). The follow-up cohort, was similarly divided: September to December 2017, 2018, and September 2019 to January 2020 (COVID-19 era follow-up). The authors used a daily migration scale index (MSI) to evaluate travel.
Overall surgical volume was decreased. The decrease in surgical volume did not correlate with the number of COVID-19 cases regionally or in each center, but was correlated with decreased MSI. In the surgical cohort, the proportions of symptomatic and emergent operations increased, while elective asymptomatic cases were not done during COVID-19 era. Nevertheless, mortality and need for ECMO was not affected. In the follow-up cohort, more patients received telephone or on-line follow-up during the COVID-19 era. The probability of death and unplanned admission was similar in the follow-up groups. Anxiety was greater in the COVID-19 era follow-up cohort.
The following graphic from the paper summarizes the main findings:
This is an interesting study that confirms what most of us perceive the impact of COVID-19 pandemic to be on congenital cardiac surgical care. The need to reallocate or restrict resources has led to decreased overall volume and prioritization of emergent, urgent and symptomatic cases. Despite this, outcomes seemed to have remained the same, as best as we can tell. However, the group that has not yet received attention is the asymptomatic, non-urgent, non-emergent cases. Will there be a negative impact on the outcomes of these patients when they eventually come to treatment? How about the patients that were unable to access care due to travel restrictions? The other group of patients that are vulnerable are those with virtual follow-up. It is unknown whether missed progression of disease will be important when physical examination could not be performed. It will take years before we can determine the true impact of the COVID-19 pandemic on our patients. We currently tend to focus on the sicker patients, but there is a greater number of “well” patients at risk.