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Yates MT, Balmforth D, Kirmani BH, Acharya M, Jeganathan R, Ngaage D, Kanani M, Deglurkar I, Lopez-Marco A, Sanders J, Ye Oo A. A multi-centre prospective cohort study of patients on the elective waiting list for cardiac surgery during the COVID-19 pandemic. J R Soc Med 2022; 115:348-353. [PMID: 35485431 DOI: 10.1177/01410768221089016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES During the worldwide COVID-19 pandemic, elective cardiac surgery was suspended to provide ICU beds for COVID-19 patients and those requiring urgent cardiac surgery. The aim of this study is to assess the effect of the pandemic on outcomes of patients awaiting elective cardiac surgery. DESIGN A multi-centre prospective cohort study. SETTING The elective adult cardiac surgery waiting list as of 1 March 2020 across seven UK cardiac surgical centres. PARTICIPANTS Patients on the elective adult cardiac surgery waiting list as of 1 March 2020 across seven UK cardiac surgical centres. MAIN OUTCOME MEASURES Primary outcome was surgery, percutaneous therapy or death at one year. METHODS Data were collected prospectively on patients on the elective adult cardiac surgery waiting list as of 1 March 2020 across seven UK cardiac surgical centres. Primary outcome was surgery, percutaneous therapy or death at one year. Demographic data and outcomes were obtained from local electronic records, anonymised and submitted securely to the lead centre for analysis. RESULTS On 1 March 2020, there were 1099 patients on the elective waiting list for cardiac surgery. On 1 March 2021, 83% (n = 916) had met a primary outcome. Of these, 840 (92%) had surgery after a median of 195 (118-262) days on waiting list, 34 (3%) declined an offer of surgery, 23 (3%) had percutaneous intervention, 12 (1%) died, 7 (0.6%) were removed from the waiting list. The remainder of patients, 183 (17%) remained on the elective waiting list. CONCLUSIONS This study has shown, for the first time, significant delays to treatment of patients awaiting elective cardiac surgery. Although there was a low risk of mortality or urgent intervention, important unmeasured adverse outcomes such as quality of life or increased perioperative risk may be associated with prolonged waiting times.
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Affiliation(s)
- Martin T Yates
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Damian Balmforth
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | | | | | | | - Dumbor Ngaage
- Hull and East Yorkshire NHS Trust, Hull, HU3 2JZ, UK
| | - Mayzar Kanani
- James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - Indu Deglurkar
- University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW, UK
| | - Ana Lopez-Marco
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Julie Sanders
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Queen Mary University of London, London, E1 4NS, UK
| | - Aung Ye Oo
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Queen Mary University of London, London, E1 4NS, UK
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2
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Bonalumi G, Giambuzzi I, Buratto B, Barili F, Garatti A, Pilozzi Casado A, Di Mauro M, Parolari A. The day after tomorrow: cardiac surgery and coronavirus disease-2019. J Cardiovasc Med (Hagerstown) 2022; 23:75-83. [PMID: 34958311 DOI: 10.2459/jcm.0000000000001223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The impact of the coronavirus disease-2019 (COVID-19) pandemic forced the governments worldwide to deal with an unprecedented health crisis. The aim of this review is to summarize what happened to cardiac surgery worldwide during the first wave of this pandemic. A literature search was performed to extrapolate key concepts regarding guidelines and reorganization of cardiac surgery wards during COVID-19. Supporting literature was also included to discuss the hot topics related to COVID-19 and cardiac surgery. Hence, both official documents from national scientific societies and single- or multiple-center experiences during the pandemics are reviewed and discussed. In Italy, the first western country hit by the pandemic, two different models were proposed to cope with the need for ICU/ward beds and to reallocate cardiac surgical services: Hub-and-Spoke system ('Hubs', dedicated to perform urgent and nondeferrable surgery, and 'Spokes', turned into COVID centers) and/or a progressive reduction in surgical activity. Worldwide, several guidelines/consensus statements were published, suggesting how to deal with the outbreak. Two different approaches for stratifying surgical indications were proposed: dynamic, based on the number of hospitalized COVID-19 patients; static, based only on the severity of the cardiovascular disease. Moreover, the importance of personal protective equipment was stressed. Several measures should have been adopted to deal with an unprecedented need for healthcare resources allocation to care for COVID-19 patients, putting the healthcare systems under serious stress. Cardiac surgery has, as have most surgical activities, been asked to reduce its own activity, giving priority to emergency and nondeferrable cases.
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Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS
- DISCCO, University of Milan
| | - Beatrice Buratto
- SC Universitary Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, Milan
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Alessandro Parolari
- Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
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3
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Gachabayov M, Latifi LA, Parsikia A, Latifi R. The Role of Telemedicine in Surgical Specialties During the COVID-19 Pandemic: A Scoping Review. World J Surg 2021; 46:10-18. [PMID: 34743242 PMCID: PMC8572066 DOI: 10.1007/s00268-021-06348-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
Background The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic. Methods This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020–August 8, 2020) and second 6-month period (August 9–March 4, 2021) of the COVID-19 pandemic. Results Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty. Conclusion Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06348-1.
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Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Lulejeta A Latifi
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,University of Arizona, Tucson, AZ, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Afshin Parsikia
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA. .,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
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4
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Pandey A, Davies WR, Calvert PA. A fatal case of infective endocarditis complicated by acute COVID-19 pneumonia. Oxf Med Case Reports 2021; 2021:omab123. [PMID: 34987853 PMCID: PMC8713583 DOI: 10.1093/omcr/omab123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/28/2021] [Accepted: 11/08/2021] [Indexed: 01/13/2023] Open
Abstract
A 74-year-old man with no co-morbidities presented to hospital with a 3-day history of diarrhoea and vomiting. He met the modified Duke’s criteria for definite infective endocarditis and was immediately started on an intravenous antibiotic. Over Days 1–9, he developed renal failure. On Day 10, he was transferred to a tertiary hospital for mitral valve replacement. However, he tested positive for SARS-CoV-2 on arrival at the tertiary hospital, which delayed his surgery. He underwent bi-weekly nasopharyngeal swabs for SARS-CoV-2 with a plan to operate as soon as he tested negative, or as soon as his incubation period for COVID-19 pneumonia had elapsed. Unfortunately, he died on Day 31 from acute respiratory distress syndrome secondary to COVID-19 pneumonia. We describe the challenges in deciding on the optimal timing for valve replacement. We conclude by suggesting that earlier valve replacement may result in better outcomes.
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Affiliation(s)
- Anmol Pandey
- North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - William R Davies
- Royal Papworth Hospital NHS Foundation Trust, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Patrick A Calvert
- Royal Papworth Hospital NHS Foundation Trust, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
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5
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Campbell L, Price S. Cardiothoracic intensive care in the time of COVID-19. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:960-962. [PMID: 34453846 PMCID: PMC8499757 DOI: 10.1093/ehjacc/zuab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Susanna Price
- Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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6
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7
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Vlastos D, Chauhan I, Mensah K, Cannoletta M, Asonitis A, Elfadil A, Petrou M, De Souza A, Quarto C, Bhudia SK, Rosendahl U, Pepper J, Asimakopoulos G. The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience. BMC Cardiovasc Disord 2021; 21:434. [PMID: 34521355 PMCID: PMC8438903 DOI: 10.1186/s12872-021-02253-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. Methods Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 with only one of the two sites resuming operative activity and compared with the respective 2019 period. A similar comparison was conducted with the period between June 2020 and August 2020, when operative activity was restored at both institutional sites. The experience of centres world-wide was invoked to assess the efficiency of our services. Results There was an initial 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9–5.2] in 2020 versus 2.1 [0.9–3.7] in 2019 (p = 0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p > 0.05 for all comparisons). Recommencement of activity at both institutional sites conferred a surgical volume within 17% of the pre-COVID-19 era. Conclusions Our institution managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.
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Affiliation(s)
| | | | - Kwabena Mensah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Ahmed Elfadil
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mario Petrou
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Cesare Quarto
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sunil K Bhudia
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - John Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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8
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Lyons M, Akowuah E, Hunter S, Caputo M, Angelini GD, Vohra HA. A survey of minimally invasive cardiac surgery during the COVID-19 pandemic. Perfusion 2021; 37:789-796. [PMID: 34247534 DOI: 10.1177/02676591211029452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. METHODS An online questionnaire was designed through the 'googleforms' platform. Responses were received from 24 out of 28 surgeons approached (85.7%), across 17 cardiac units. RESULTS There was a strong consensus against a higher risk of conversion from minimally invasive to full sternotomy (92%; n = 22) nor there is increased infection (79%; n = 19) or bleeding (96%; n = 23) with MICS compared to full sternotomy during the pandemic. The majority of respondents (67%; n = 16) felt that it was safe to perform MICS during COVID-19, and that it should not be halted (71%; n = 17). London cardiac units experienced a decrease in MICS (60%; n = 6), whereas non-London units saw no reduction. All London MICS surgeons wore an FP3 mask compared to 62% (n = 8) of non-London MICS surgeons, 23% (n = 3) of which only wore a surgical mask. London MICS surgeons felt that routine double gloving should be done (60%; n = 6) whereas non-London MICS surgeons held a strong consensus that it should not (92%; n = 12). CONCLUSION Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics.
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Affiliation(s)
- Megan Lyons
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Enoch Akowuah
- Department of Cardiac Surgery, South Tees Hospital, Middlesborough, UK
| | - Steve Hunter
- Department of Cardiac Surgery, Northern General Hospital, Sheffield, UK
| | - Massimo Caputo
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK.,Department of Cardiac Surgery/Cardiovascular Sciences, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery/Cardiovascular Sciences, University of Bristol, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery/Cardiovascular Sciences, University of Bristol, Bristol, UK
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Obika BD, Dolezova N, Ponzo S, Valentine S, Shah S, Gledhill J, Plans D, Nicholson C, Walters C, Stephen L, Ng S, Ayres J, Petrou M, Bhudia S, Denny C, Schrauwers H, Markides V. Implementation of a mHealth solution to remotely monitor patients on a cardiac surgical waiting list: service evaluation. JAMIA Open 2021; 4:ooab053. [PMID: 34355134 PMCID: PMC8331328 DOI: 10.1093/jamiaopen/ooab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The emergence of COVID-19 resulted in postponement of nonemergent surgical procedures for cardiac patients in London. mHealth represented a potentially viable mechanism for highlighting deteriorating patients on the lengthened cardiac surgical waiting lists. OBJECTIVE To evaluate the deployment of a digital health solution to support continuous triaging of patients on a cardiac surgical waiting list. METHOD An NHS trust utilized an app-based mHealth solution (Huma Therapeutics) to help gather vital information on patients awaiting cardiac surgery (valvular and coronary surgery). Patients at a tertiary cardiac center on a waiting list for elective surgery were given the option to be monitored remotely via a mobile app until their date of surgery. Patients were asked to enter their symptoms once a week. The clinical team monitored this information remotely, prompting intervention for those patients who needed it. RESULTS Five hundred and twenty-five patients were on boarded onto the app. Of the 525 patients using the solution, 51 (9.71%) were identified as at risk of deteriorating based on data captured via the remote patient monitoring platform and subsequently escalated to their respective consultant. 81.7% of patients input at least one symptom after they were on boarded on the platform. DISCUSSION Although not a generalizable study, this change in practice clearly demonstrates the feasibility and potential benefit digital remote patient monitoring can have in triaging large surgical wait lists, ensuring those that need care urgently receive it. We recommend further study into the potential beneficial outcomes from preoperative cardiac mHealth solutions.
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Affiliation(s)
| | - Nikola Dolezova
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - Sonia Ponzo
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - Sophie Valentine
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - Sachin Shah
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - Jonathan Gledhill
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - David Plans
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - Conor Nicholson
- Research and Development Department, Huma Therapeutics Limited, London, UK
| | - Cathy Walters
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Laura Stephen
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Serena Ng
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Janet Ayres
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Mario Petrou
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sunil Bhudia
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Clare Denny
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Hillary Schrauwers
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vias Markides
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Pring ET, Malietzis G, Kendall SWH, Jenkins JT, Athanasiou T. Crisis management for surgical teams and their leaders, lessons from the COVID-19 pandemic; A structured approach to developing resilience or natural organisational responses. Int J Surg 2021; 91:105987. [PMID: 34091086 DOI: 10.1016/j.ijsu.2021.105987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/01/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple industries and organisations are afflicted by and respond to institutional crises daily. As surgeons, we respond to crisis frequently and individually such as with critically unwell patients or in mass casualty scenarios; but rarely, do we encounter institutional or multi-institutional crisis with multiple actors as we have seen with the COVID-19 pan-demic. Businesses, private industry and the financial sector have been in a more precar-ious position regarding crisis and consequently have developed rapid response strate-gies employing foresight to reduce risk to assets and financial liquidity. Moreover, large nationalised governmental organisations such as the military have strategies in place ow-ing to a rapidly evolving geopolitical climate with the expectation of immediate new chal-lenges either in the negotiating room or indeed the field of conflict. Despite both nation-alised and privatised healthcare systems existing, both appeared ill-prepared for the COVID-19 global crisis. METHODS A narrative review of the literature was undertaken exploring the approach to crisis man-agement and models used in organisations exposed to institutional crises outside the field of medicine. RESULTS There are many parallels between the organisational management of private business institutions, large military organisations and surgical organisational management in healthcare. Models from management consultancies and the armed forces were ex-plored discussed and adapted for the surgical leader providing a framework through which the surgical leader can bring about an successful response to an institutional crisis and ensure future resilience. CONCLUSION We believe that healthcare, and surgeons (as leaders) in particular, can learn from these other organisations and industries to engage appropriate generic operational plans and contingencies in preparation for whatever further crises may arise in the future, both near and distant. As such, following a review of the literature, we have explored a number of models we believe are adaptable for the surgical community to ensure we remain a dy-namically responsive and ever prepared profession.
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Affiliation(s)
- Edward T Pring
- Department of Surgery, St Mark!s Hospital, Watford Road, Harrow, HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK; Chartered Management Institute, 77 Kingsway, London, WC2B 6SR, UK.
| | - George Malietzis
- Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK
| | - Simon W H Kendall
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK; Society for Cardiothoracic Surgery in Great Britain and Ireland & Hon President, Society Clinical Perfusion Scientists of Great Britain and Ireland, UK
| | - John T Jenkins
- Department of Surgery, St Mark!s Hospital, Watford Road, Harrow, HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK
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11
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Juraszek A, Kuriata J, Kołsut P, Hryniewiecki T, Różewicz-Juraszek M, Dziodzio T, Kuśmierczyk M. Literature-based considerations regarding organizing and performing cardiac surgery against the backdrop of the coronavirus pandemic. J Cardiothorac Surg 2021; 16:73. [PMID: 33836795 PMCID: PMC8034512 DOI: 10.1186/s13019-021-01419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ongoing coronavirus disease 2019 (Covid-19) pandemic presents challenges for surgeons of all disciplines, including cardiologists. The volume of cardiac surgery cases has to comply with the mandatory constraints of healthcare capacities. The treatment of Covid-19-positive patients must also be considered. Unfortunately, no scientific evidence is available on this issue. Therefore, this study aimed to offer some consensus-based considerations, derived from available scientific papers, regarding the organization and performance of cardiac surgery against the backdrop of the Covid-19 pandemic. METHODS Key recommendations were extracted from recent literature concerning cardiac surgery. RESULTSː Reducing elective cardiac procedures should be based on frequent clinical assessment of patients on the waiting list (every one or two weeks) and the current local status of the Covid-19 pandemic. Screening tests at admission for every patient are broadly recommended. Where appropriate, alternative treatment methods can be considered, including percutaneous techniques and minimally invasive surgery, if performed by experienced cardiac surgery teams. CONCLUSIONS There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients' clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays.
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Affiliation(s)
- Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology, Alpejska 42, 04-628, Warszawa, Poland.
| | - Jarosław Kuriata
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology, Alpejska 42, 04-628, Warszawa, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology, Alpejska 42, 04-628, Warszawa, Poland
| | - Tomasz Hryniewiecki
- Department of Valvular Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, Warsaw, Poland
| | - Monika Różewicz-Juraszek
- Department of Valvular Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, Warsaw, Poland
| | - Tomasz Dziodzio
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology, Alpejska 42, 04-628, Warszawa, Poland
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12
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Sanders J, Akowuah E, Cooper J, Kirmani BH, Kanani M, Acharya M, Jeganathan R, Krasopoulos G, Ngaage D, Deglurkar I, Yiu P, Kendall S, Oo AY. Cardiac surgery outcome during the COVID-19 pandemic: a retrospective review of the early experience in nine UK centres. J Cardiothorac Surg 2021; 16:43. [PMID: 33752706 PMCID: PMC7983084 DOI: 10.1186/s13019-021-01424-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/11/2021] [Indexed: 12/30/2022] Open
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.
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Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK.
- William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Jackie Cooper
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mazyar Kanani
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Metesh Acharya
- Department of Cardiothoracic Surgery, Glenfield Hospital, University Hospitals Leicester NHS Foundation Trust, Leicester, UK
| | - Reuben Jeganathan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dumbor Ngaage
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Indu Deglurkar
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, Wales, UK
| | - Patrick Yiu
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Aung Ye Oo
- St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
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13
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Lopez‐Marco A, Harky A, Verdichizzo D, Hope E, Rosser B, McPherson I, Kelly R, Holland L, Ye Oo A. Early experience of aortic surgery during the COVID-19 pandemic in the UK: A multicentre study. J Card Surg 2021; 36:848-856. [PMID: 33442890 PMCID: PMC8013563 DOI: 10.1111/jocs.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND A significant restructuring of the healthcare services has taken place since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, with elective surgery put on hold to concentrate intensive care resources to treat COVID-19 as well as to protect patients who are waiting for relatively low risk surgery from exposure to potentially infected hospital environment. METHODS Multicentre study, with 19 participating centers, to define the impact of the pandemic on the provision of aortovascular services and patients' outcomes after having adapted the thresholds for intervention to guarantee access to treatment for emergency and urgent conditions. Retrospective analysis of prospectively collected data, including all patients with aortovascular conditions admitted for surgical or conservative treatment from the 1st March to the 20th May 2020. RESULTS A total of 189 patients were analyzed, and 182 underwent surgery. Diagnosis included: aneurysm (45%), acute aortic syndrome (44%), pseudoaneurysm (4%), aortic valve endocarditis (4%), and other (3%). Timing for surgery was: emergency (40%), urgent (34%), or elective (26%). In-hospital mortality was 12%. Thirteen patients were diagnosed with COVID-19 during the peri-operative period, and this subgroup was not associated with a higher mortality. CONCLUSIONS There was a significant change in service provision for aortovascular patients in the UK. Although the emergency and urgent surgical activity were maintained, elective treatment was minimal during early months of the pandemic. The preoperative COVID-19 screening protocol, combined with self-isolation and shielding, contributed to the low incidence of COVID-19 in our series and a mortality similar to that of pre-pandemic outcomes.
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Affiliation(s)
- Ana Lopez‐Marco
- Department of Cardiothoracic SurgeryBarts Heart Centre, St. Bartholomew's HospitalLondonUK
| | - Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK,Department of Integrative Biology, Faculty of Health and Life ScienceUniversity of LiverpoolLiverpoolUK,Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUK,Department of Congenital Cardiac SurgeryAlder Hey Children HospitalLiverpoolUK
| | | | - Emma Hope
- Department of Cardiothoracic SurgeryUniversity Hospital of SouthamptonSouthamptonUK
| | - Barbara Rosser
- Department of Cardiothoracic SurgeryRoyal Brompton and Harefield NHS TrustLondonUK
| | - Iain McPherson
- Department of Cardiothoracic SurgeryFreeman HospitalNewcastleUK
| | - Ronan Kelly
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfastUK
| | - Luke Holland
- Department of Cardiothoracic SurgeryRoyal Sussex County HospitalBrightonUK
| | - Aung Ye Oo
- Department of Cardiothoracic SurgeryBarts Heart Centre, St. Bartholomew's HospitalLondonUK
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14
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Hussain A, Ike DI, Durand-Hill M, Ibrahim S, Roberts N. Sternal wound infections during the COVID-19 pandemic: an unexpected benefit. Asian Cardiovasc Thorac Ann 2020; 29:376-380. [PMID: 33241715 DOI: 10.1177/0218492320977633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The novel coronavirus, now termed SARS-CoV-2, has had a significant impact on cardiac surgical services globally. Although drastically reduced, our institution has maintained a significant level of cardiac surgical activity during the pandemic. Rigorous COVID-19 guidelines have been instituted to mitigate the risk of viral transmission. We observed a reduction in sternal wound infections since the institution of new perioperative surgical guidelines. METHODS We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since a national lockdown was declared in March 2020. A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the national lockdown, as a baseline cohort group, was also performed. RESULTS A total of 2600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. During the COVID-19 pandemic, there were 4 sternal wound infections with an overall incidence of 0.8%. In comparison, the incidence of sternal wound infections was significantly higher at 3.0% in the 12-month period prior to lockdown with 63 sternal wound infections (p = 0.006). CONCLUSION This report suggests a significant role of iatrogenic causes in sternal wound infections prior to the pandemic. The strict implementation of guidelines in the perioperative period suggests that sternal wound infections can be prevented. We propose that the now widespread COVID-19 guidelines to reduce transmission risk be adapted to help reduce the incidence of sternal wound infections.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - David I Ike
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | | | - Sammra Ibrahim
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Neil Roberts
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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15
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Lopez-Marco A, Rosser B, Harky A, Verdichizzo D, McPherson I, Hope E, Qadri S, Oo A. The fate of patients with acute aortic syndrome during the coronavirus disease 2019 (COVID-19) pandemic: A UK multicenter study. ACTA ACUST UNITED AC 2020; 5:17-25. [PMID: 34172983 PMCID: PMC7690305 DOI: 10.1016/j.xjon.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 01/04/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care services across the world. There has been a significant restructuring of health care resources to protect services for patients with COVID-19–related illness and to maintain emergency and urgent medical and surgical activity. This study assessed access to emergency treatment, logistical challenges, and outcomes of patients with acute aortic syndrome during the early months of the COVID-19 pandemic in the United Kingdom. Methods This was a multicenter study, from March 1 to May 20, 2020 that included 19 cardiac centers, was a retrospective analysis of prospectively collected data obtained from individual centers' national cardiac surgical databases. Demographic details, choice of treatment, operative details, and outcomes were collected. COVID-19 screening, timing of surgery, and outcomes of COVID-19–positive and –negative patients were also analyzed. Results In total, 88 patients presented with acute aortic syndrome to participating centers from March 1 to May 20, 2020. There were 79 aortic dissections (89.8%), 7 intramural hematomas (7.9%), and 2 penetrating aortic ulcers (2.3%). Seventy-nine patients (89.8%) underwent surgery. In-hospital mortality was 25.3% (n = 20). Postoperative complications included 13.9% postoperative stroke (11.4% permanent and 2.3% temporary), 16.5% rate of hemofiltration, and 10.1% rate of tracheostomy. Nine patients were treated conservatively with a mortality of 60%. Seven patients were diagnosed with COVID-19, and there was no associated mortality. Conclusions Despite extensive restructuring of health care resources, access to emergency and urgent treatment for patients with acute aortic syndrome was maintained in the early months of the COVID-19 pandemic in the United Kingdom. Clinical outcomes were similar to the prepandemic period.
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Affiliation(s)
- Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Barbara Rosser
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Danilo Verdichizzo
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Iain McPherson
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, United Kingdom
| | - Emma Hope
- Department of Cardiothoracic Surgery, Southampton University Hospital, Southampton, United Kingdom
| | - Syed Qadri
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Aung Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
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16
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Yates MT, Balmforth D, Lopez-Marco A, Uppal R, Oo AY. Outcomes of patients diagnosed with COVID-19 in the early postoperative period following cardiac surgery. Interact Cardiovasc Thorac Surg 2020; 31:483-485. [PMID: 32791519 PMCID: PMC7454553 DOI: 10.1093/icvts/ivaa143] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 12/04/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has disrupted patient care across the NHS. Following the suspension of elective surgery, priority was placed in providing urgent and emergency surgery for patients with no alternative treatment. We aim to assess the outcomes of patients undergoing cardiac surgery who have COVID-19 infection diagnosed in the early postoperative period. We identified 9 patients who developed COVID-19 infection following cardiac surgery. These patients had a significant length of hospital stay and extremely poor outcomes with mortality of 44%. In conclusion, the outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. In order to offer cardiac surgery, units must implement rigorous protocols aimed at maintaining a COVID-19 protective environment to minimize additional life-threatening complications related to this virus infection.
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Affiliation(s)
- Martin T Yates
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Damian Balmforth
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Rakesh Uppal
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Aung Y Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
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17
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Balmforth D, Yates MT, Lau K, Hussain A, Lopez-Marco A, Edmondson S, Oo A, Uppal R. Cardiothoracic surgery in the midst of a pandemic: Operative outcomes and maintaining a coronavirus disease 2019 (COVID-19)-free environment. ACTA ACUST UNITED AC 2020; 4:107-114. [PMID: 34173548 PMCID: PMC7510586 DOI: 10.1016/j.xjon.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022]
Abstract
Objective In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic. Methods Data on all patients undergoing cardiothoracic surgery at a single tertiary referral center in London were prospectively collated during the first 7 weeks of lockdown in the United Kingdom. A comprehensive protocol was implemented to maintain a COVID-19-free environment including the preoperative screening of all patients, the use of full personal protective equipment in areas with aerosol-generating procedures, and separate treatment pathways for patients with and without the virus. Results A total of 156 patients underwent major cardiac and thoracic surgery over the study period. Operative mortality was 9% in the cardiac patients and 1.4% in thoracic patients. The preoperative COVID-19 protocol implemented resulted in 18 patients testing positive for COVID-19 infection and 13 patients having their surgery delayed. No patients who were negative for COVID-19 infection on preoperative screening tested positive postoperatively. However, 1 thoracic patient tested positive on intraoperative bronchoalveolar lavage. Conclusions Our early experience demonstrates that it is possible to perform major cardiac and thoracic surgery with low operative mortality and zero development of postoperative COVID-19 infection.
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Affiliation(s)
- Damian Balmforth
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom.,Queen Mary University of London, London, United Kingdom
| | - Martin T Yates
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Kelvin Lau
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Stephen Edmondson
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Aung Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom.,Queen Mary University of London, London, United Kingdom
| | - Rakesh Uppal
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom.,Queen Mary University of London, London, United Kingdom
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18
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Narayan P. Cardiac surgery in presence of concomitant corona virus disease-2019 infection. J Card Surg 2020; 35:3653-3654. [PMID: 32939820 DOI: 10.1111/jocs.14981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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19
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Affiliation(s)
- Amer Harky
- Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK.,Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Grace Poole
- St George's School of Medicine, University of London, London, UK
| | - Ariana Axiaq
- School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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20
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Affiliation(s)
- Azhar Hussain
- Department of Cardiac Surgery, St. Bartholomew's Hospital, London, UK
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21
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Fudulu DP, Angelini GD, Vohra H. The Pan London Emergency Cardiac Surgery service blueprint. J Card Surg 2020; 35:1767-1768. [PMID: 32598516 DOI: 10.1111/jocs.14749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors share their experience of managing the cardiac surgery services across London during the challenging Covid-19 pandemic. The Pan London Emergency Cardiac Surgery Service model could serve as a blueprint to design policies applicable to other surgical specialities and parts of the UK and worldwide.
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22
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Hussain A, Balmforth D, Yates M, Lopez-Marco A, Rathwell C, Lambourne J, Roberts N, Lall K, Edmondson S. The Pan London Emergency Cardiac Surgery service: Coordinating a response to the COVID-19 pandemic. J Card Surg 2020; 35:1563-1569. [PMID: 32598501 PMCID: PMC7361315 DOI: 10.1111/jocs.14747] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Over the last 4 months, the novel coronavirus, SARS-CoV-2, has caused a significant economic, political, and public health impact on a global scale. The natural history of the disease and surge in the need for invasive ventilation has required the provision of intensive care beds in London to be reallocated. NHS England have proposed the formation of a Pan-London Emergency Cardiac surgery (PLECS) service to provide urgent and emergency cardiac surgery for the whole of London. In this initial report, we outline our experience of setting up and delivering a pan-regional service for the delivery of urgent and emergency cardiac surgery with a focus on maintaining a COVID-free in-hospital environment. In doing so, we hope that other regions can use this as a starting point in developing their own region-specific pathways if the spread of coronavirus necessitates similar measures be put in place across the United Kingdom.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Damian Balmforth
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Martin Yates
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Ana Lopez-Marco
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Claire Rathwell
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | | | - Neil Roberts
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Kulvinder Lall
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Stephen Edmondson
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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- Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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