The impact of resource allocation during the COVID-19 pandemic on cardiac surgical practice and patient outcomes: a systematic review

Abstract

OBJECTIVES The COVID-19 pandemic has shaken the world and placed enormous strain on healthcare systems globally. In this systematic review, we investigate the effect of resource allocation on cardiac surgery programs and the impact on patients awaiting elective cardiac surgery. METHODS PubMed and Embase were systematically searched for articles published from January 1st 2019-August 30th 2022. This systematic review included studies investigating the impact of the COVID-19 pandemic on resource allocation and the subsequent influence on cardiac surgery outcomes. 1,676 abstracts and titles were reviewed and 20 studies were included in this review. RESULTS During the COVID-19 pandemic, resources were allocated away from elective cardiac surgery to help support the pandemic response. This resulted in increased wait times for elective patients, increased rates of urgent or emergent surgical intervention, and increased rates of mortality or complications for patients awaiting or undergoing cardiac surgery during the pandemic. CONCLUSIONS While the finite resources available during the pandemic were often insufficient to meet the needs of all patients as well as the influx of new COVID-19 patients, resource allocation away from elective cardiac surgery resulted in prolonged wait times, more frequent urgent or emergent surgeries, and negative impacts on patient outcomes. Understanding the impacts of delayed access to care with regards to urgency of care, increased morbidity and mortality, and increased utilization of resources per indexed case needs to be considered to navigate through pandemics to minimize the lingering effects that continue to negatively impact patient outcomes.

The Dual Effect of COVID-19 Pandemic and Medical Consumables Policy on Cardiac Surgery care in China: a Multicenter Cohort Study

“…A substantial body of literature has demonstrated a dramatic drop in admissions of patients with coronary syndrome [6-8] and adult cardiac surgery volume [9][10][11][12] following the outbreak of COVID-19 pandemic, resulting in backlogs of cases awaiting cardiac surgery [5,23]. In line with previous studies, the pandemic onset was also associated with an immediate sharp decline of adult cardiac surgery volume (percentage change: 54•80%, 95% CI:…”

“…It has been reported that the pandemic was associated with a greater risk of morbidity and mortality [10][11][12].…”

“…The increased strain on healthcare service, coupled with the fear of being infected by the virus, has led to less priority to cardiac specialties and a decrease in accessibility to medical care among patients with cardiac symptoms [6][7][8]. As a result, the volume of cardiac surgery experienced a signi cant drop [9][10][11][12]. In addition, it has been reported that COVID-19 pandemic was associated with increased costs, morbidity and mortality among patients who underwent cardiac surgeries [10][11][12][13][14][15].…”

“…As a result, the volume of cardiac surgery experienced a signi cant drop [9][10][11][12]. In addition, it has been reported that COVID-19 pandemic was associated with increased costs, morbidity and mortality among patients who underwent cardiac surgeries [10][11][12][13][14][15].…”