New research by the University of Bristol highlights how the COVID-19 pandemic affected elective surgery in children with congenital heart disease
During the COVID-19 pandemic, healthcare services were reallocated, which led to delays in elective surgeries for children with congenital heart disease. This process occurred to ensure children who were critically ill and needed emergency or life-saving surgery could be treated first.
The research published in Open Heart suggests that this prioritisation did not increase post-operative complication rates or death.
The COVID-19 pandemic caused unprecedented disruption across healthcare services
At the start of the COVID-19 pandemic, pressure on healthcare resources affected hospitals, with an increase in COVID-19 patients, hospitals were forced to postpone elective procedures like specialist surgeries for congenital heart disease in children. However, children with this condition require several repeat surgeries to maintain a healthy heart structure and function as they grow.
The researchers aimed to assess, in children under 16 years old, the impact of congenital heart disease procedures in England during different pandemic periods compared with pre-pandemic periods in hopes of informing future responses to healthcare disruptions. The team also investigated whether there was an increase in post-procedure complications and post-procedure death during these periods, when compared to the pre-pandemic period.
Analysing over 26,000 congenital heart disease procedures
The researchers analysed 26,270 procedures from 17,860 children in England between 1 January 2018 and 31 March 2022, linking them to primary/secondary care data. The study period included pre-pandemic and pandemic phases, including three restriction periods and the corresponding relaxation periods.
The study found the median number of congenital heart disease procedures per week was lower during all pandemic periods compared to pre-pandemic levels. The most significant reductions occurred during the first, most severe restrictions, and the relaxation period following the second restrictions, coinciding with winter pressures.
These reductions were primarily a result of fewer elective procedures, whilst urgent and emergency/life-saving procedures remained stable compared to pre-pandemic rates. There was evidence of prioritising cardiac surgery over catheterisation and prioritising infants during the pandemic. The researchers found limited evidence of increased post-procedure complications or death during the pandemic compared to the pre-pandemic levels.
Dr Arun Karthikeyan Suseeladevi, Senior Research Associate in Medical Statistics and Health Data Science at Bristol Medical School: Population Health Sciences (PHS), and principal author, said: “Our results suggest that when pressures on health services result in prioritisation of urgent, emergency and life-saving procedures in children with CHD and delaying elective procedures, this does not result in increased post-procedure complications or mortality, over two years.
“These findings have implications for future health service provision, particularly during infectious disease epidemics or global pandemics as well as during extreme weather events common across Europe.
“Notably, during the relaxation period following the second restriction, the median rates of overall and elective procedures dropped to levels similar to those in the first restriction period, exceeding the reductions seen during the second restriction. This second relaxation occurred during winter (3 December 2020 to 5 January 2021) and might reflect winter pressures.
“As climate change intensifies the frequency of weather extremes, such pressures are likely to rise, highlighting the need for strategies to mitigate climate change and effective plans to manage health services pressures from various sources.”
Professor Deborah Lawlor, British Heart Foundation Professor of Cardiovascular Science and senior author on the paper, explained: “These findings are reassuring whilst cautioning that they cannot tell us about what happened to individual patients. In particular, we need to explore what longer-term effects there might be on the children whose surgery was delayed and their families. As we continue to collect more information data, we hope to be able to determine whether those children and their families had any adverse heart or mental health effects from the delayed surgery.”
