The Surge After the Surge: Cardiac Surgery Post-COVID-19
The Surge After the Surge: Cardiac Surgery Post-COVID-19
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DOI：
10.1016/j.athoracsur.2020.04.018
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发表时间：
2020-12-01
影响因子：
4.6
通讯作者：
Gammie, James S.
中科院分区：
文献类型：
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作者：
Salenger, Rawn;Etchill, Eric W.;Gammie, James S.
背景2019冠状病毒病（COVID-19）大流行导致成人心脏手术病例数量大幅减少，因为机构和外科医生减少了非紧急手术。在大流行期间，推迟的病例将逐步增加，一旦限制放松，将需要在有限的时间内完成。我们调查了大流行后医院运营能力提高的不同程度对清除积压的延期病例的时间的影响。我们收集了来自2个卫生系统的4个心脏手术项目的数据。我们记录了基线和COVID-19疫情期间的病例率，并创建了一个数学模型，以根据预计的疫情持续时间量化累计手术积压。然后，我们使用该模型预测清除积压所需的时间，具体取决于增加的运营能力水平。实施限制后，心脏手术量下降到基线的54%。假设服务恢复日期为6月1日或7月1日，我们计算出需要分别执行每月基线量的216%或263%，才能在1个月内清除积压。清理积压工作所需的实际时间在很大程度上取决于COVID后时期的医院能力，范围从1到8个月不等，取决于服务何时恢复以及能力增加的程度。COVID-19恢复期间的心脏外科手术能力将对清除延迟积压病例的时间产生重大影响。业务能力不足可能造成严重延误，并增加发病率和死亡率。如果只有大流行前的能力，积压的工作将永远无法清除。(C)2020年美国胸外科医师协会
Background. 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.Methods. 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.Results. 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.Conclusions. 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. (C) 2020 by The Society of Thoracic Surgeons