Impact of COVID-19 on operation room utilization efficiency and cardiac surgery care pathway: single centre experience

Background: The coronavirus disease 2019 (COVID-19) pandemic has severely impacted theatre utilization and patient care in cardiac surgery. This study assesses impact on theatre utilisation efficiency and cardiac care pathway during COVID compared to the preCOVID period. Methods: Operation room (OR) data for preCOVID period (1(st) January to 23(rd) March 2020) for major cardiac cases were compared to COVID period for predefined indices of OR utilisation and efficiency. Categorical variables were compared with Chi-squared and continuous variables with Man-Whitney U test. P value <0.05 was considered significant. Results: Total 363 surgeries were logged (preCOVID =304, COVID =59). There was significant reduction in cases/day (median 5 cases/day preCOVID to 1 case/day during COVID, P<0.001). OR utilization capacity was less than 50% for 36/65 (55.38%) COVID days vs. 5/59 (8.48%) preCOVID days (P<0.001). Almost half the COVID days (43.08%) had no operations. Patients during COVID were younger (median 62 vs. 69 years, P<0.001) but higher risk (logEuroscore 6.6 vs. 4.7, P=0.193). Index of operational efficiency (InOE) remained unchanged (preCOVID 78.8% vs. COVID 79%, P=0.90). COVID adversely affected surgical efficiency (preCOVID 74% vs. COVID 68.5%, P<0.001). Conclusions: There was significantly decreased workflow during the COVID period due to reprioritization of resources. Operational service could be delivered to higher efficiencies despite significant changes in patient care pathways through a standardised approach.