Early Outcomes and Complications Following Cardiac Surgery in Patients Testing Positive for Coronavirus Disease 2019: An International Cohort Study

The outbreak of severe acute respiratory syndromecoronavirus-2, the cause of coronavirus disease 2019 (COVID-19) in December 2019 represented a global emergency accounting for more than 2.5 million deaths worldwide. It has had an unprecedented influence on cardiac surgery internationally, resulting in cautious delivery of surgery and restructuring of services. Understanding the influence of COVID-19 on patients after cardiac surgery is based on assumptions from other surgical specialties and single-center studies.

The COVIDSurg Collaborative conducted a multicenter cohort study, including 1128 patients, across 235 hospitals, from 24 countries demonstrating perioperative COVID-19 infection was associated with an overall mortality of 24% and postoperative pulmonary complications in half of all patients. Cardiac surgery arguably represents a higher risk population than general or orthopedic surgery due to the high American Society of Anesthesiologists grades and multiple comorbidities usually seen. We present a subgroup analysis of COVIDSurg data, including patients who underwent cardiac surgery between March 1, 2020, and July 31, 2020, across 13 countries, with a confirmed perioperative (7 days preoperative up to 30 days postoperative) diagnosis of COVID-19 infection.

This study confirms increased mortality and respiratory complications associated with perioperative COVID-19 infection highlighting the need for COVID clean pathways and postdischarge shielding of cardiac surgery patients, caregivers, and relatives. Further work is required to ascertain the influence of delays to surgery on those still requiring cardiac surgery.