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\begin{document}

\title{A multi-centre analysis of cardiac surgery referral patterns and
resource allocation during the COVID-19 pandemic}



\author[1]{Damian Balmforth}%
\author[1]{Ana Lopez-Marco}%
\author[1]{Martin Yates}%
\author[1]{Benjamin Adams}%
\author[2]{Alex Cale}%
\author[3]{Reuben Jeganathan}%
\author[4]{Indu Deglurkar }%
\author[5]{Bilal Kirmani}%
\author[6]{Mazyar Kanani}%
\author[7]{Giovanni Mariscalco}%
\author[8]{Saleem Jahangeer}%
\author[9]{George Krasopoulos}%
\author[10]{Mohamed Sherif}%
\author[11]{Yasir Ahmed}%
\author[1]{Aung Oo}%
\author[12]{Julie Sanders}%
\affil[1]{Saint Bartholomew's Hospital}%
\affil[2]{Hull University Teaching Hospitals NHS Trust}%
\affil[3]{Royal Victoria Hospital}%
\affil[4]{University Hospital of Wales Healthcare NHS Trust}%
\affil[5]{Liverpool Heart and Chest Hospital NHS Foundation Trust}%
\affil[6]{James Cook University Hospital}%
\affil[7]{University Hospitals of Leicester NHS Trust}%
\affil[8]{Manchester University NHS Foundation Trust}%
\affil[9]{Oxford University Hospitals NHS Foundation Trust}%
\affil[10]{Sheffield Teaching Hospitals NHS Foundation Trust}%
\affil[11]{Swansea Bay University Health Board}%
\affil[12]{St Bartholomew's Hospital}%


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  \date{May 26, 2024}


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\begin{abstract}
Background and aims: The COVID-19 pandemic caused a dramatic shift in
the provision of cardiac surgical services in the United Kingdom (UK)
with all elective surgery suspended. We sought to explore referral
patterns, changes in clinical decision making and resource allocation to
adult cardiac surgical services in the UK during the first wave of the
pandemic. Methods: Data from 11 UK centres on referrals and available
health resources (operating theatre and bed capacity) for urgent or
emergency adult cardiac surgery between the 1st March 2020 and the 1st
August 2020 was collated, and securely transferred to the lead centre
for analysis. Results: 1113 patients were referred for cardiac surgery
over the study period. Following UK lockdown in March 2020 the number of
referrals initially fell to 39\% of pre-lockdown levels before
recovering to 211\% of that seen prior to the pandemic. A change in
treatment strategies was observed with a trend towards deferring surgery
entirely or favouring less invasive, non-surgical treatments. At the
peak of the pandemic in April 2020, theatre availability and bed
capacity fell to 26\% and 54\% of pre-lockdown levels, respectively.
Provision for emergency surgery was maintained throughout at 1 to 2
emergency lists per unit weekly. Conclusion: During the first wave of
the UK COVID-19 pandemic cardiac surgical operative activity dropped
acutely before increasing over the next four months. Despite this drop,
provision for emergency surgery was retained throughout. In the event of
further waves of COVID-19 pandemic, maintaining essential cardiac
surgical services should be prioritised.%
\end{abstract}%



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