The Surge after the Surge: Cardiac Surgery post-COVID-19

Rawn Salenger, Eric W. Etchill, Niv Ad, Thomas Matthew, Diane Alejo, Glenn Whitman, Jennifer S. Lawton, Christine L. Lau, Charles F. Gammie, James S. Gammie

Research output: Contribution to journalArticle


BACKGROUND: The COVID-19 pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail non-urgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame once restrictions ease. We investigated the impact of various levels of increased post-pandemic hospital operating capacity on the time to clear the backlog of deferred cases. METHODS: We collected data from four cardiac surgery programs across two health systems. We recorded case rates at baseline and during the COVID-19 pandemic. We created a mathematical model to quantify the cumulative surgical backlog based on the projected pandemic duration. We then used our model to predict the time required to clear the backlog depending on the level of increased operating capacity. RESULTS: Cardiac surgery volumes fell to 54% of baseline after restrictions were implemented. Assuming a service restoration date of either June 1 or July 1, we calculated the need to perform 216% or 263% of monthly baseline volume, respectively, to clear the backlog in one month. The actual duration required to clear the backlog is highly dependent on hospital capacity in the post-COVID time period, and ranges from one to eight months depending on when services are restored and degree of increased capacity. CONCLUSIONS: Cardiac surgical operating capacity during the COVID-19 recovery period will have a dramatic impact on the time to clear the deferred cases backlog. Inadequate operating capacity may cause substantial delays and increase morbidity and mortality. If only pre-pandemic capacity is available, the backlog will never clear.

Original languageEnglish (US)
JournalThe Annals of thoracic surgery
StateAccepted/In press - May 3 2020


  • cardiac surgery
  • coronary artery bypass grafting
  • COVID-19
  • surgical capacity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Salenger, R., Etchill, E. W., Ad, N., Matthew, T., Alejo, D., Whitman, G., Lawton, J. S., Lau, C. L., Gammie, C. F., & Gammie, J. S. (Accepted/In press). The Surge after the Surge: Cardiac Surgery post-COVID-19. The Annals of thoracic surgery.