Lessons learned by thoracic surgeons during the COVID-19 pandemic

Helen J Madsen; Anne Lambert-Kerzner; Ellison Mucharsky; Joseph D Phillips; Elizabeth A David; David D Odell; Adam R Dyas; Robert A Meguid

doi:10.21037/jtd-22-920

Lessons learned by thoracic surgeons during the COVID-19 pandemic

J Thorac Dis. 2023 Feb 28;15(2):507-515. doi: 10.21037/jtd-22-920. Epub 2023 Feb 9.

Authors

Helen J Madsen¹, Anne Lambert-Kerzner^{1

2}, Ellison Mucharsky¹, Joseph D Phillips^{3

4}, Elizabeth A David^{1

4}, David D Odell^{4

5

6}, Adam R Dyas¹, Robert A Meguid^{1

2

4}

Affiliations

¹ Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
² Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.
³ Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
⁴ Thoracic Surgery Outcomes Research Network (ThORN), Inc., Lebanon, NH, USA.
⁵ Division of Thoracic Surgery, Canning Thoracic Institute Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁶ Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Abstract

Background: The scale of the coronavirus disease 2019 (COVID-19) pandemic has necessitated healthcare systems to adapt and evolve, altering physician roles and expectations. Thoracic surgeons have seen practice changes from new COVID-19 consults to necessary delay and triage of elective care. The goal of this study was to understand the impact of COVID-19 on thoracic surgeon experiences in order to anticipate roles and changes in practice in future such circumstances.

Methods: Semi-structured, qualitative individual telephone interviews were conducted with thoracic surgeons. Interviews were structured to understand how surgeons were impacted by the COVID-19 pandemic and to record lessons learned. Interviews were conducted until thematic saturation was achieved. Data were analyzed using matrix analysis.

Results: Eleven board-certified general thoracic surgeons from nine institutions were interviewed. Thoracic surgeon roles in COVID-19 care included critical care delivery, performing tracheostomies and establishing related protocols, and interventions for long-term airway complications. Attention was called to the impact of the pandemic on thoracic cancer: patients avoided hospitals because of concern over COVID-19, delaying care.

Conclusions: Thoracic surgeons played a critical role in the COVID-19 pandemic response in both technical patient care and administrative capacities. Primary care responsibilities included the development, administration and delivery of tracheostomy protocols, and the care of down-stream airway complications. Thoracic surgeons were critical in triage decisions to minimize the impact of COVID-19 on thoracic cancer care. Lessons learned during the COVID-19 pandemic may provide insight into opportunities to promote collaboration in thoracic surgery and facilitate improved care delivery in future settings of resource limitation.

Keywords: Coronavirus disease 2019 (COVID-19); lessons learned; pandemic; qualitative; thoracic surgery COVID-19.