The Surge After the Surge: Cardiac Surgery Post-COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail nonurgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame...

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Vydáno v:	The Annals of thoracic surgery Ročník 110; číslo 6; s. 2020
Hlavní autoři:	Salenger, Rawn, Etchill, Eric W, Ad, Niv, Matthew, Thomas, Alejo, Diane, Whitman, Glenn, Lawton, Jennifer S, Lau, Christine L, Gammie, Charles F, Gammie, James S
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Netherlands 01.12.2020
Témata:	Betacoronavirus Cardiac Surgical Procedures - statistics & numerical data Coronavirus Infections - epidemiology Coronavirus Infections - prevention & control COVID-19 Elective Surgical Procedures - statistics & numerical data Humans Infection Control - organization & administration Models, Statistical Pandemics - prevention & control Pneumonia, Viral - epidemiology Pneumonia, Viral - prevention & control Procedures and Techniques Utilization SARS-CoV-2 Surge Capacity - statistics & numerical data
ISSN:	1552-6259, 1552-6259
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Abstract	The coronavirus disease 2019 (COVID-19) pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail nonurgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame once restrictions ease. We investigated the impact of various levels of increased postpandemic hospital operating capacity on the time to clear the backlog of deferred cases. We collected data from 4 cardiac surgery programs across 2 health systems. We recorded case rates at baseline and during the COVID-19 pandemic and created a mathematical model to quantify the cumulative surgical backlog based on the projected pandemic duration. We then used the model to predict the time required to clear the backlog depending on the level of increased operating capacity. Cardiac surgery volumes fell to 54% of baseline after restrictions were implemented. Assuming a service restoration date of either June 1 or July 1, we calculated the need to perform 216% or 263% of monthly baseline volume, respectively, to clear the backlog in 1 month. The actual duration required to clear the backlog highly depends on hospital capacity in the post-COVID period, and ranges from 1 to 8 months, depending on when services are restored and the degree of increased capacity. Cardiac surgical operating capacity during the COVID-19 recovery period will have a dramatic impact on the time to clear the deferred cases backlog. Inadequate operating capacity may cause substantial delays and increase morbidity and mortality. If only prepandemic capacity is available, the backlog will never clear.
AbstractList	The coronavirus disease 2019 (COVID-19) pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail nonurgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame once restrictions ease. We investigated the impact of various levels of increased postpandemic hospital operating capacity on the time to clear the backlog of deferred cases.BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail nonurgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame once restrictions ease. We investigated the impact of various levels of increased postpandemic hospital operating capacity on the time to clear the backlog of deferred cases.We collected data from 4 cardiac surgery programs across 2 health systems. We recorded case rates at baseline and during the COVID-19 pandemic and created a mathematical model to quantify the cumulative surgical backlog based on the projected pandemic duration. We then used the model to predict the time required to clear the backlog depending on the level of increased operating capacity.MethodsWe collected data from 4 cardiac surgery programs across 2 health systems. We recorded case rates at baseline and during the COVID-19 pandemic and created a mathematical model to quantify the cumulative surgical backlog based on the projected pandemic duration. We then used the model to predict the time required to clear the backlog depending on the level of increased operating capacity.Cardiac surgery volumes fell to 54% of baseline after restrictions were implemented. Assuming a service restoration date of either June 1 or July 1, we calculated the need to perform 216% or 263% of monthly baseline volume, respectively, to clear the backlog in 1 month. The actual duration required to clear the backlog highly depends on hospital capacity in the post-COVID period, and ranges from 1 to 8 months, depending on when services are restored and the degree of increased capacity.ResultsCardiac surgery volumes fell to 54% of baseline after restrictions were implemented. Assuming a service restoration date of either June 1 or July 1, we calculated the need to perform 216% or 263% of monthly baseline volume, respectively, to clear the backlog in 1 month. The actual duration required to clear the backlog highly depends on hospital capacity in the post-COVID period, and ranges from 1 to 8 months, depending on when services are restored and the degree of increased capacity.Cardiac surgical operating capacity during the COVID-19 recovery period will have a dramatic impact on the time to clear the deferred cases backlog. Inadequate operating capacity may cause substantial delays and increase morbidity and mortality. If only prepandemic capacity is available, the backlog will never clear.ConclusionsCardiac surgical operating capacity during the COVID-19 recovery period will have a dramatic impact on the time to clear the deferred cases backlog. Inadequate operating capacity may cause substantial delays and increase morbidity and mortality. If only prepandemic capacity is available, the backlog will never clear. The coronavirus disease 2019 (COVID-19) pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail nonurgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame once restrictions ease. We investigated the impact of various levels of increased postpandemic hospital operating capacity on the time to clear the backlog of deferred cases. We collected data from 4 cardiac surgery programs across 2 health systems. We recorded case rates at baseline and during the COVID-19 pandemic and created a mathematical model to quantify the cumulative surgical backlog based on the projected pandemic duration. We then used the model to predict the time required to clear the backlog depending on the level of increased operating capacity. Cardiac surgery volumes fell to 54% of baseline after restrictions were implemented. Assuming a service restoration date of either June 1 or July 1, we calculated the need to perform 216% or 263% of monthly baseline volume, respectively, to clear the backlog in 1 month. The actual duration required to clear the backlog highly depends on hospital capacity in the post-COVID period, and ranges from 1 to 8 months, depending on when services are restored and the degree of increased capacity. Cardiac surgical operating capacity during the COVID-19 recovery period will have a dramatic impact on the time to clear the deferred cases backlog. Inadequate operating capacity may cause substantial delays and increase morbidity and mortality. If only prepandemic capacity is available, the backlog will never clear.
Author	Ad, Niv Lawton, Jennifer S Etchill, Eric W Alejo, Diane Gammie, Charles F Matthew, Thomas Salenger, Rawn Whitman, Glenn Lau, Christine L Gammie, James S
Author_xml	– sequence: 1 givenname: Rawn surname: Salenger fullname: Salenger, Rawn email: rawnsalenger@umm.edu organization: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: rawnsalenger@umm.edu – sequence: 2 givenname: Eric W surname: Etchill fullname: Etchill, Eric W organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 3 givenname: Niv surname: Ad fullname: Ad, Niv organization: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Adventist White Oak Medical Center, Silver Spring, Maryland – sequence: 4 givenname: Thomas surname: Matthew fullname: Matthew, Thomas organization: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Division of Cardiothoracic Surgery, Suburban Hospital, Bethesda, Maryland – sequence: 5 givenname: Diane surname: Alejo fullname: Alejo, Diane organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 6 givenname: Glenn surname: Whitman fullname: Whitman, Glenn organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 7 givenname: Jennifer S surname: Lawton fullname: Lawton, Jennifer S organization: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 8 givenname: Christine L surname: Lau fullname: Lau, Christine L organization: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland – sequence: 9 givenname: Charles F surname: Gammie fullname: Gammie, Charles F organization: Department of Astronomy, University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois; Department of Physics, University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois – sequence: 10 givenname: James S surname: Gammie fullname: Gammie, James S organization: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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SubjectTerms	Betacoronavirus Cardiac Surgical Procedures - statistics & numerical data Coronavirus Infections - epidemiology Coronavirus Infections - prevention & control COVID-19 Elective Surgical Procedures - statistics & numerical data Humans Infection Control - organization & administration Models, Statistical Pandemics - prevention & control Pneumonia, Viral - epidemiology Pneumonia, Viral - prevention & control Procedures and Techniques Utilization SARS-CoV-2 Surge Capacity - statistics & numerical data
Title	The Surge After the Surge: Cardiac Surgery Post-COVID-19
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