St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK.
William Harvey Research Institute, Queen Mary University of London, London, UK.
J Cardiothorac Surg. 2021 Mar 22;16(1):43. doi: 10.1186/s13019-021-01424-y.
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.
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.
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).
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.
早期研究得出结论，患有 COVID-19 的患者死亡风险很高，但没有研究专门探讨心脏手术的结果。我们调查了 COVID-19 大流行早期英国心脏手术的结果。
这是一项回顾性观察性研究，纳入了 2020 年 3 月 1 日至 4 月 30 日期间在英国 9 个中心接受心脏手术的所有成年患者。数据从国家心血管结果研究成人心脏手术数据库、重症监护国家审计和研究中心数据库以及当地电子系统中获取并在当地进行链接。由主要中心对匿名数据集进行分析。统计分析包括描述性统计、倾向评分匹配（PSM）、条件逻辑回归和分层分位数回归。
在纳入的 755 名个体中，有 53 名（7.0%）患有 COVID-19。与患有 COVID-19 和未患有 COVID-19 的患者相比，患有 COVID-19 的患者死亡率更高（24.5%比 3.5%，p<0.0001），术后住院时间更长（11 天比 6 天，p=0.001），这两者在 PSM 后仍然显著。术前诊断为 COVID-19 的患者的恢复方式与非 COVID-19 患者相似。然而，术后诊断为 COVID-19 的患者仍需在医院多住 5 天（12 天比 7 天，p=0.024），且死亡率明显高于术前诊断为 COVID-19 的患者（37.1%比 0.0%，p=0.005）。
为了降低 COVID-19 的风险，特别是术后负担，需要制定强有力且有效的术前诊断方案，并采取有效的策略来维持无 COVID-19 的环境。专门的心脏手术中心可能有助于安全且持续地开展心脏手术。
