Flu Season Unlikely to Affect Elective Heart Surgery Outcomes in Older Adults

By Marilynn Larkin

December 31, 2020

NEW YORK (Reuters Health) - Among older adults who underwent elective coronary and aortic valve surgery during influenza seasons, "no consistent associations" were seen between the severity of the season and risk of death or readmission, a retrospective analysis suggests.

"The study supports the current practice where surgeons do not reschedule elective surgeries based on the severity of influenza seasons," Dr. Makoto Mori of Yale New Haven Hospital in Connecticut told Reuters Health by email. "We were surprised to see no significant difference in the risk of readmission related to respiratory illness. Cardiac surgery tends to have a substantive respiratory complication rate, so it was surprising and reassuring to see that influenza seasonal severity did not appear to worsen the risk."

As reported in JAMA Network Open, Dr. Mori and colleagues analyzed Medicare fee-for-service data on more than 313,000 patients who underwent elective coronary artery bypass grafting (CABG) and the 135,500 who underwent surgical aortic valve replacement (SAVR) during flu seasons from 2003-2017. In the CABG group, the median age was 73 and 71% were men; in the SAVR group, the median age was 76 and 61% were men.

Six flu seasons were mild (based on rates of influenza-associated hospitalizations and deaths related to pneumonia or influenza), five were moderate, and four were severe during the study period.

Compared with CABG procedures done during mild flu seasons, those performed during moderate (odds ratio, 1.06) and severe (OR, 1.06) seasons had higher associated risks of 30-day mortality.

For SAVR, the 30-day mortality risk was not significantly higher in moderate (OR, 1.03) or severe (OR, 1.01) seasons compared with mild seasons.

Further, all-cause readmission risk was not statistically significantly higher for either CABG or SAVR procedures performed during moderate (OR, 0.99 for both) or severe seasons seasons (OR, 0.92 for CABG; OR, 0.93 for SAVR) compared with flu seasons of mild severity.

Dr. Mori said, "The COVID era has a unique challenge of critical care resource constraints and having to triage resource-intensive surgeries, including cardiac surgery, because of that. In settings where resources are not an issue, our study supports hospitals to keep providing these operations to patients in need without postponing them even during the pandemic of communicable respiratory disease."

Dr. John Puskas, Chairman, Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, Mount Sinai Beth Israel and Mount Sinai West in New York City, commented in an email to Reuters Health, "Because COVID-19 is significantly more lethal than influenza, the conclusions of this study should not be directly extrapolated to our management of cardiovascular disease during the present pandemic."

"That said, many cardiovascular specialists, epidemiologists and public health officials have become alarmed at the 'excess' non-COVID mortality that has been recorded during the pandemic, coincident with a precipitous decline in patients treated for cardiovascular disease in the US," he said. "It seems likely that fear of COVID has prompted many patients to neglect cardiovascular disease, including symptomatic MI, stroke, aortic dissection etc., with a resultant spike in non-COVID mortalities."

Therefore, he said, "our message to Americans must be to encourage patients to not defer treatment of cardiovascular illnesses during this pandemic. That is unnecessary and has been shown to be profoundly counterproductive and dangerous."

Dr. Bryan Whitson, a cardiothoracic surgeon at The Ohio State University Wexner Medical Center in Columbus, also commented by email. "We have not seen an increase or any significant incidence in COVID or influenza in general cardiac surgery patients. This may be due to our stringent institutional policies around screening and quarantining prior to admission and rechecking once in the hospital. In the hospital, universal mask and barrier precautions are used for all providers and hospital visitation is limited."

"We have not seen nearly the amount of influenza or viral pneumonitis this year as compared to previous," he added, "and this may be a result of physical distancing, masks and hand hygiene."

SOURCE: https://bit.ly/381VRpm JAMA Network Open, online December 23, 2020.