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      Early experience of aortic surgery during the COVID‐19 pandemic in the UK: A multicentre study

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          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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          Most cited references9

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          Coronavirus Disease 2019 in the Perioperative Period of Lung Resection: A Brief Report From a Single Thoracic Surgery Department in Wuhan, People’s Republic of China

          Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, People’s Republic of China, and has subsequently spread worldwide. Clinical information on patients who contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the perioperative period is limited. Here, we report seven cases with confirmed SARS-CoV-2 infection in the perioperative period of lung resection. Retrospective analysis suggested that one patient had been infected with the SARS-CoV-2 infection before the surgery and the other six patients contracted the infection after the lung resection. Fever, lymphopenia, and ground-glass opacities revealed on computed tomography are the most common clinical manifestations of the patients who contracted COVID-19 after the lung resection. Pathologic studies of the specimens of these seven patients were performed. Pathologic examination of patient 1, who was infected with the SARS-CoV-2 infection before the surgery, revealed that apart from the tumor, there was a wide range of interstitial inflammation with plasma cell and macrophage infiltration. High density of macrophages and foam cells in the alveolar cavities, but no obvious proliferation of pneumocyte, was found. Three of seven patients died from COVID-19 pneumonia, suggesting lung resection surgery might be a risk factor for death in patients with COVID-19 in the perioperative period.
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            The impact of COVID‐19 on the provision of cardiac surgical services

            Abstract The global pandemic caused by COVID‐19 has had a significant global impact on healthcare systems. One implication of this pandemic is the cancellation of elective cardiac surgeries and the centralization of services. As a result, hospitals in Europe, North America, and the United Kingdom have had to alter the services offered to patients to be able to cope with service provision for COVID infected patients. Data should be collected during this period to provide a good insight following the lockdown period to understand the implication of such service alteration. Future research should also focus on the effects on long‐term mortality and morbidity as well as financial implications on hospitals as a result of these changes.
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              Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta

              Background Thoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England. Methods and Results Data from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta‐analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished. Treatment and mortality rates were investigated. A total of 24 548 adult patients in the HES study, 8058 in the NACSA study, and 103 543 from a total of 33 studies in the systematic review were obtained. Treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between English counties. Risk‐adjusted 6‐month mortality in untreated patients ranged from 19.4% to 36.3%. Regional variation persisted after adjustment for disease or patient factors. Regional cardiac units with higher case volumes treated more‐complex patients and had significantly lower risk‐adjusted mortality relative to low‐volume units. The results of the systematic review indicated that the delivery of care by multidisciplinary teams in high‐volume units resulted in better outcomes. The observational analyses and the online survey indicated that this is not how services are configured in most units in England. Conclusions Changes in the organization of services that address unwarranted variation in the provision of care for patients with thoracic aortic disease in England may result in more‐equitable access to treatment and improved outcomes.
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                Author and article information

                Contributors
                aaharky@gmail.com
                Journal
                J Card Surg
                J Card Surg
                10.1111/(ISSN)1540-8191
                JOCS
                Journal of Cardiac Surgery
                John Wiley and Sons Inc. (Hoboken )
                0886-0440
                1540-8191
                13 January 2021
                March 2021
                : 36
                : 3 ( doiID: 10.1111/jocs.v36.3 )
                : 848-856
                Affiliations
                [ 1 ] Department of Cardiothoracic Surgery Barts Heart Centre, St. Bartholomew's Hospital London UK
                [ 2 ] Department of Cardiothoracic Surgery Liverpool Heart and Chest Hospital Liverpool UK
                [ 3 ] Department of Integrative Biology, Faculty of Health and Life Science University of Liverpool Liverpool UK
                [ 4 ] Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK
                [ 5 ] Department of Congenital Cardiac Surgery Alder Hey Children Hospital Liverpool UK
                [ 6 ] Department of Cardiothoracic Surgery John Radcliffe Hospital Oxford UK
                [ 7 ] Department of Cardiothoracic Surgery University Hospital of Southampton Southampton UK
                [ 8 ] Department of Cardiothoracic Surgery Royal Brompton and Harefield NHS Trust London UK
                [ 9 ] Department of Cardiothoracic Surgery Freeman Hospital Newcastle UK
                [ 10 ] Department of Cardiothoracic Surgery Royal Victoria Hospital Belfast UK
                [ 11 ] Department of Cardiothoracic Surgery Royal Sussex County Hospital Brighton UK
                Author notes
                [*] [* ] Correspondence Amer Harky, MRCS, MSc, Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Dr, L14 3PE, Liverpoopl, UK.

                Email: aaharky@ 123456gmail.com

                Author information
                http://orcid.org/0000-0001-9330-3948
                http://orcid.org/0000-0001-5507-5841
                Article
                JOCS15307
                10.1111/jocs.15307
                8013563
                33442890
                ac3500af-8f9f-4d90-8b9b-83b0496d4351
                © 2021 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 December 2020
                : 24 December 2020
                Page count
                Figures: 4, Tables: 3, Pages: 9, Words: 4847
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                aorta,aortic dissection,aortic surgery,pandemic
                aorta, aortic dissection, aortic surgery, pandemic

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