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

Abstract

Abstract Background China introduced Reforms on High Value Medical Consumables (RHVMC) to reduce expenses during COVID-19 pandemic. However, there exists a paucity of data regarding the adult cardiac surgical care under the combined effect of COVID-19 pandemic and RHVMC policy. Methods This cohort included data on cardiac surgery patients aged over 18 years, based on medical records from 17 Chinese hospitals from January 2019 to December 2019 (prepandemic period) and January 2020 to December 2021 (pandemic and RHVMC period). Interrupted time series analysis were used to estimate the change in monthly cardiac surgery admissions between the two periods. Additionally, multivariable regression and propensity score matching (PSM) analyses were used to assess the association of COVID-19 pandemic and RHVMC with in-hospital mortality, complications, 30-day readmissions, length of stay (LOS) and costs at patient-level. Results This study included 8154 cardiac surgery patients with mean (SD) age of 60.60(10.28) years in the prepandemic cohort and 60.75(10.48) years in the pandemic and RHVMC cohort. The period of pandemic and RHVMC was associated an immediate 47.04% decrease (95CI: -60.56%- -48,20%) followed by a gradual monthly 2.22% (95CI: 0.85%- 3.62%) increase in the volume of cardiac surgery, and 30.32% increase followed by monthly 2.47% decrease in hospitalization proportions based on ITS analyses. Multivariable and PSM analyses showed that the period of pandemic and RHVMC was associated a 5%, 3% and 52% decrease in LOS, costs and risk of cerebral infraction/hemorrhage; but a 66% and 81% increase in the risk of arrhythmia and pneumonia. The in-hospital mortality and 30-day readmissions were similar between the two periods. Conclusions The combination of COVID-19 pandemic and RHVMC was associated with a reduction in LOS and costs, but an increase in the risk of arrhythmia and pneumonia among cardiac surgery patients. Future attention should be focused on the risk of arrhythmia and pneumonia in these patients.