Dong Tim, Briffa Norman, Narayan Pradeep, Chan Jeremy, Angelini Gianni D
Bristol Heart Institute, Bristol University, Bristol, BS2 8HW, United Kingdom.
Cardiothoracic Surgery Department, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom.
Eur J Cardiothorac Surg. 2025 Aug 2;67(8). doi: 10.1093/ejcts/ezaf246.
The full extent of the COVID-19 pandemic's impact during different phases of the pandemic and the recovery of cardiac surgical services in the United Kingdom have not been comprehensively assessed. This study aims to evaluate these disruptions' impact and immediate recovery on delivering adult cardiac surgical care in the United Kingdom.
The periods investigated were divided into pre-lockdown, first lockdown, first relaxation, second lockdown, second relaxation, third lockdown, and post-lockdown (recovery). Changes in surgical practice, early and mid-term clinical outcomes, and hospital readmission were analysed using various metrics across different time periods.
Coronary artery bypass grafts were the most performed procedure across all time periods, with the average number of urgent and emergency increasing compared to the pre-pandemic period. Aortic valve replacement was the next most frequent, followed by combined aortic valve and coronary artery bypass surgery. However, those procedures remained predominantly elective across all periods. There was a significant change in 30-day mortality rates across the pandemic phases (P < .001), with higher mortality observed post-pandemic. There was a gradual increase in the waiting times for elective and urgent surgeries from January 2018 to March 2022. Patients who had surgery before March 2020 had a significantly lower hazard of mid-term mortality than those who were operated on after this period (HR, 0.638; 95% CI, 0.5875-0.6921). All procedures showed gradual recovery across the pandemic periods following an initial decline at the beginning of the pandemic.
COVID-19 had a significant negative impact on adult cardiac surgical case mix and volume and has not recovered to the pre-pandemic levels. This work, we believe, is important for policymakers, healthcare providers, and patients, as it offers insights into the challenges faced by a critical healthcare sector during a global crisis and highlights potential avenues for improvement.
新冠疫情不同阶段的全面影响以及英国心脏外科服务的恢复情况尚未得到全面评估。本研究旨在评估这些干扰因素对英国成人心脏外科护理的影响以及即时恢复情况。
所调查的时期分为封锁前、首次封锁、首次解封、第二次封锁、第二次解封、第三次封锁以及封锁后（恢复）阶段。使用不同时间段的各种指标分析手术实践、早期和中期临床结果以及医院再入院情况的变化。
冠状动脉搭桥术在所有时间段都是实施最多的手术，与疫情前相比，紧急和急诊手术的平均数量有所增加。主动脉瓣置换术是其次实施最频繁的手术，其次是主动脉瓣和冠状动脉搭桥联合手术。然而，这些手术在所有时期仍主要为择期手术。疫情各阶段的30天死亡率有显著变化（P < 0.001），疫情后观察到更高的死亡率。从2018年1月到2022年3月，择期和紧急手术的等待时间逐渐增加。2020年3月之前接受手术的患者中期死亡风险明显低于在此之后接受手术的患者（风险比，0.638；95%置信区间，0.5875 - 0.6921）。所有手术在疫情初期下降后，在整个疫情期间都显示出逐渐恢复的趋势。
新冠疫情对成人心脏外科病例组合和手术量产生了重大负面影响，尚未恢复到疫情前水平。我们认为，这项工作对政策制定者、医疗服务提供者和患者都很重要，因为它揭示了一个关键医疗领域在全球危机期间所面临的挑战，并突出了潜在的改进途径。
