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Disclosures: The authors report no relevant financial disclosures.
June 01, 2020
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Drop in type A aortic dissection surgeries during COVID-19 pandemic raises concerns

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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During the height of the COVID-19 pandemic in New York, cases requiring surgical repair of acute type A aortic dissection dropped dramatically in the city, according to a new report.

The decline may be due to an increase in patients dying at home and/or not wanting to present to the ED because of fear of acquiring COVID-19 at the hospital, the researchers wrote in the Journal of the American College of Cardiology.

“From conversations with other aortic surgeons in New York City and posts on social media, we noticed we were all seeing fewer and fewer acute cases, whether aortic dissections or STEMIs,” Ismail El-Hamamsy, MD, PhD, FRCSC, system director of aortic surgery and Randall B. Griepp Professor of Cardiovascular Surgery at The Mount Sinai Health System, told Healio. “Seeing that other groups were observing the same decline, we decided to look at it in a more objective and scientific way by pooling all data from all centers in New York City, which is the center of the pandemic. We thought that if what we are noticing individually is real, then it would be indicative of a broader public health issue.”

Case volume dropped

Surgical case volume of acute type A aortic dissections at 11 New York hospitals averaged 12.8 cases per month between January 2018 and February 2020, but fell to three cases per month between March 1 and April 15, 2020, a drop of 76.5% (difference, 9.8; 95% CI, 2.95-16.67; P = .007), El-Hamamsy and colleagues wrote.

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Ismail El-Hamamsy, MD, PhD, FRCSC, system director of aortic surgery and Randall B. Griepp Professor of Cardiovascular Surgery at The Mount Sinai Health System

“This is all speculative, but there is no doubt that the fear that people have of going to an emergency department is real, especially at the height of the pandemic; it has come down a bit now because we have tamed our fears in a way,” El-Hamamsy told Healio. “In March and early April, there was so much anxiety that people felt if they went to the emergency department, they would possibly catch COVID-19 and die. There was a lot of avoidance of hospitals and emergency departments, which I think is a big part of the answer, but there may also be other factors.”

Other possible factors include delays in emergency medical technician (EMT) response long enough for the patient to die before transport and failure to confirm aortic dissection via CT scans, which at the height of the pandemic in New York were primarily reserved for patients with suspected COVID-19, he said.

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An analysis of cases in New York from the first 4 months of each of the last 3 years confirmed the volume of cases between March 1 and April 15 was unusually low.

‘A real signal’

“It started as an anecdote, but when we put it together, it turned out to be a real signal. It’s a warning that these are all avoidable deaths,” El-Hamamsy told Healio. “When you look at the number of at-home deaths in New York City during that period, it increased by eight to 10 times, from about 25 deaths at home per day to 200 to 250 during the 3 or 4 weeks that the pandemic was at its height. Part of that is COVID, but part is probably these other emergencies.”

Public health messaging must emphasize that ED visits remain necessary for suspected acute emergencies, he said.

“The one caveat that maybe was not expressed clearly enough was if you experience anything that makes you feel like you need to seek urgent care, you should not refrain from doing so because of fear of going to the hospital or of breaking social distancing rules,” he said in an interview. “At the end of the day, there is a risk in avoiding risk by not going to the emergency department.”

For more information:

Ismail El-Hamamsy, MD, PhD, FRCSC, can be reached at ismail.el-hamamsy@mountsinai.org.

Disclosures: The authors report no relevant financial disclosures.