Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone?

Islam M Shehata; Amir Elhassan; Jai Won Jung; Ivan Urits; Omar Viswanath; Alan D Kaye

doi:10.1016/j.bpa.2020.07.005

Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone?

Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):643-650. doi: 10.1016/j.bpa.2020.07.005. Epub 2020 Jul 18.

Authors

Islam M Shehata¹, Amir Elhassan², Jai Won Jung³, Ivan Urits⁴, Omar Viswanath⁵, Alan D Kaye⁶

Affiliations

¹ Ain Shams Hospital, Department of Anesthesiology, Cairo, Egypt.
² Desert Regional Medical Center, Cardiothoracic Anesthesia, Palm Springs, CA, USA.
³ Georgetown University School of Medicine, Washington, DC, USA.
⁴ Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: ivanurits@gmail.com.
⁵ Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA.
⁶ Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA.

Abstract

During this coronavirus disease 2019 (COVID-19) pandemic, there is an international call to postpone all elective surgeries. Cardiac surgery carries a combined risk for cardiac patients, who are at risk for higher complications of COVID-19, and healthcare workers. In response to the COVID-19 pandemic, the American College of Surgeons and the American Society of Anesthesiologists recommended a sustained reduction in the rate of new COVID-19 cases for 14 days before the resumption of the elective surgery, but postponing surgery may impact patients' daily activities and increase the risk the of deterioration of their cardiac condition. We will discuss the risks and benefits of the decision whether to postpone or proceed with elective cardiac surgical procedures during the escalating COVID-19 pandemic considering the specific risk of the cardiac patients, the unique characteristics of the surgery, and the international health system capacity.

Keywords: COVID-19; benefits; elective cardiac surgery; pandemic; risks.

Publication types

Review

MeSH terms

Betacoronavirus*
COVID-19
Cardiac Surgical Procedures*
Coronavirus Infections / prevention & control*
Elective Surgical Procedures*
Humans
Pandemics / prevention & control*
Pneumonia, Viral / prevention & control*
SARS-CoV-2
Time