Trends and variations in Canadian thoracic surgical volume and perioperative practice during the COVID-19 pandemic

Abstract

Background: Thoracic surgeons in Canada responded to the COVID-19 pandemic without existing precedence. The primary aim of this study was to understand how thoracic surgery care in Canada was affected by the pandemic in terms of volume, perioperative management, and patterns of practice. Methods: Data were obtained using 2 questionnaires (18-item surgeon-specific and 13-item institution-specific questionnaires) in addition to the Canadian Association of Thoracic Surgery (CATS) national database. Outcomes included qualitative surgeon experiences and thoracic surgery volume from March 2020 to December 2022. Centres were separated into 3 levels of COVID-19 burden based on community prevalence. Results: We received survey responses from 63 surgeons and 6 institutions. Inperson consultation dropped by 57% during the pandemic. Preoperative cancer workups experienced minor (≤ 4 wk, 39%) and major (≥ 8 wk, 27%) delays. Operable lung and esophageal cancer experienced minor delays in treatment, while pure ground-glass opacities and benign esophageal pathology experienced major delays (25%) or cancellations (21%). Medical education shifted to virtual platforms, decreasing student involvement by 81%. Perceived factors affecting operating room availability included lack of staff, beds, and personal protective equipment. Conclusion: There was a pan-Canadian reduction in thoracic surgery volume, regardless of regional COVID-19 caseload. Prioritization of thoracic oncology was observed, with a delay in care for minimally invasive and benign illness. Our findings illustrate how surgeons and institutions responded to the pandemic and inform strategies for Canadian thoracic practice in the event of future analogous events.