key: cord-0763947-m6wnj83d
authors: Seese, Laura; Aranda-Michel, Edgar; Sultan, Ibrahim; Morell, Victor O.; Mathier, Michael A.; Mulukutla, Suresh R.; Saba, Samir; Dueweke, Eric J.; Levenson, Joshua E.; Kilic, Arman
title: Programmatic Responses to the Coronavirus Pandemic: A Survey of 502 Cardiac Surgeons
date: 2020-04-28
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2020.04.014
sha: b5d531b6a10f9b08277019d1d953134ddb4394e8
doc_id: 763947
cord_uid: m6wnj83d

nan

The rapid emergence and spread of coronavirus disease 2019 (COVID-19) has presented disruptive challenges to the healthcare system in the United States (US). In response, there have been systems-based changes within US cardiac surgical programs in efforts to enhance containment measures and to preserve essential resources needed to treat an influx of COVID-19 patients. The World Health Organization identified COVID-19 as a global pandemic on March 11, 2020 and within days, many cardiac surgical programs made drastic changes to their clinical practices with reductions in surgical volume due to delayed elective cases, reassignment of providers to intensive care settings outside their usual scope of practice, and the integration of virtual clinics for patient evaluation (1) . As these systems-based changes were evolving, guidelines with adequate specificity to address the complexity of decision-making for delaying cardiac surgery were unavailable. As a result, many hospital systems in combination with their heart teams developed program-specific policies. We surveyed US cardiac surgeons to gain insights into the variability of programmatic responses to COVID-19.

On March 31, 2020, an email invitation to complete an anonymous 10-question survey was sent to US attending-level, cardiac surgeons. Email addresses and information on career status and specialty were obtained from the Cardiothoracic Surgery Network Surgeon Profiles (2) . Reminder invitations were sent at 72-hours and two weeks after the initial request. This study was approved by the institutional review board at the University of Pittsburgh.

The survey was sent to 2,991 cardiac surgeons and attained 502 responses (16.8%).

Most respondents were either in academic, cardiac surgery practices (35.3%, n=177) or private practice with a combination of cardiac and general thoracic surgery (37.4%, n=188) (Figure 1 ).

Most practice locations were in large, metropolitan areas (42.2%, n=212). Numbers of confirmed COVID-19 patients within the respondent's hospital systems varied between >100 (17.2%, n=88) and none (2.7%, n=13). However, at the majority of centers, no patients confirmed to be COVID-19 positive had undergone cardiac surgery (81.7%, n=410). Many programs have transitioned to only providing urgent or emergent cardiac surgery (81.2%, n=408) and adopted the utilization of telemedicine services in either some cases or all nonemergent cases (54.1%, n=262 and 35.9%, n=180, respectively). The majority of programs saw a reduction in greater than 50% of cardiac surgical volume (76.2%, n=383) (Figure 2) . These unknowingly within the COVID-19 incubation period, a practice that has been shown to exacerbate the pulmonary consequences of the virus (4). The balance between COVID-related risks associated with proceeding with surgery versus the risks of cardiovascular complications arising from delaying of non-urgent cardiac operations can be delicate with many unknowns on both sides. In addition, despite recommendations to undergo operative intervention, some patients refuse to come to the hospital out of fear of COVID-19 exposure. As the experience with the COVID-19 pandemic continues to evolve, the outcomes of patients for whom surgery was delayed will be an important metric to evaluate.

In conclusion, this survey of 502 cardiac surgeons demonstrates major changes in practice as a response to the COVID-19 pandemic. Lessons from the early US cardiac surgery response to COVID-19 that can be extrapolated to future pandemics include the importance of involving cardiac surgeons in policy decisions regarding cardiovascular patients, the need for enhanced communication between hospital leadership and service lines as well as improved access to PPE for all providers. The collective experience from the COVID-19 pandemic can help serve as a catalyst to prepare permanent systems-based plans for future pandemic response situations. 

Thoracic Surgery Outcomes Research Network, Inc. COVID-19 Guidance for Triage of Operations for Thoracic Malignancies: A Consensus Statement from Thoracic Surgery Outcomes Research Network

Cardiothoracic Surgery Network: Surgeon Profiles

Reperfusion of STEMI in the COVID-19 Era -Business as Usual?

Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection