THE IMPACT OF SARS-COV-2 IN VASCULAR SURGICAL ACTIVITY IN A TERTIARY HOSPITAL

  • Rita Carreira Garcia Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal https://orcid.org/0000-0002-5135-0196
  • Frederico Bastos Gonçalves Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal https://orcid.org/0000-0002-9825-9007
  • Rita Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Joana Catarino Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Isabel Vieira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Ricardo Correia Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal https://orcid.org/0000-0002-0509-3715
  • Rita Bento Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Fábio Pais Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Tiago Ribeiro Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Joana Cardoso Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Emília Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
Keywords: COVID-19, Vascular Surgery, Outcomes

Abstract

Introduction/Objectives: The Corona Virus Disease of 2019 (COVID-19) has taken a major toll on the public health system, with restrictions in all clinical activity, from consultations and exams to number and type of surgeries. Patients apprehension to resort to medical aid and hospitals leads to late admissions and, in our perception, more severe presentations of the underlying pathology, namely, in Chronic limb threatening ischemia (CLTI). Need for testing prior to non-emergent surgery causes larger delays in the referral of patients, and this, added to the reduction of surgical times and ICU availability, potentially results in worse outcomes. The aim of this study was to objectively evaluate the type pathology that was treated during the emergency state and to compare the outcome of the surgical procedures with the same period of 2018 and 2019.

Methods: A retrospective analysis of the patient charts from patients submitted to surgery in the months of March and April of the year 2020 was conducted and compared to the same period on the previous two years. The primary endpoint was death at 30 days or during hospital stay and the secondary endpoints were pathology classification, grade of ischemia, amputation, amputation level, type of surgery (endovascular, conventional or hybrid), time of hospital stay and reintervention.

Results: There were 98 patients submitted to surgery in the COVID period (CP), compared to 286 in the Non-COVID period (NCP). There was no significant difference in the age (70 years (17–98) in the CP vs. 69 (17–92) in the NCP, p=.13) or sex profile of the patients (76% male (n=74) in the CP vs. 70% (n=196) in the NCP, p=.26). There was no statistical difference in mortality (5% (n=5) in the CP vs. 5% (n=13) in the NCP, p=.88). There was a statistically significant decrease in conventional surgery (43% (n=42) in the CP vs. 57% (n=164) in the NCP, p=.04), but no statistically significant difference in length of hospital stay(10 (0–77) days in the CP vs. 7 (0–118) in the NCP, p=.6), and reintervention (18% (n=18) in the CP vs. 16% (n=45) in the NCP, p=.58). PAD corresponded to 75% (n=73) of the admissions in the CP vs. 48% (n=137) in the NCP, p=.02. CLTI corresponded to 99% (n=70) of the PAD population in the CP, vs. 93% (n=114) in the NCP, p=.1, with a significant increase in the number of patients presenting with Rutherford Grades 5 and 6 (81% (n=57) in the CP, vs. 68% (n=77) in the NCP, p=.03). There was a non-significant decrease in amputation rate (35% (n=25) vs. 40% (n=49), p=.49) and increase of major limb amputation (52% (n=13) vs. 39% (n=19), p=.27). The second most frequent pathology was aneurysmal aortic and iliac disease, but there was a statistically significant reduction in the number of patients treated (5% (n=5) in the CP vs. 13% (n=36) in the NCP, p=.05). All aortic aneurysms treated in 2020 were ruptured (100% (n=5) vs. 42% (n=15) in the NCP, p=0.2). There was no significant difference in mortality in urgent aortic aneurysm repair between groups (60% (n=3) in the CP vs. 47% (n=7) in the NCP, p=.77).

Conclusions: COVID-19 restrictions manifested mainly in the type of pathology treated and the number of patients operated on. The gravity of the underlying pathology, manifested by more serious wounds and advanced CLTI at presentation, did not increase mortality nor was reflected on limb amputations rates. Aortic and iliac aneurismal disease was the second most common pathology treated but with a significant decrease in total number of cases and no significant difference in mortality.

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References

1. COVIDSurg Collaborative (2020). Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. The British journal of surgery, 10.1002/bjs.11746. Advance online publication. https://doi.org/10.1002/bjs.11746

2. Stahel P. F. (2020). How to risk-stratify elective surgery during the COVID-19 pandemic?. Patient safety in surgery, 14, 8. https://doi.org/10.1186/s13037-020-00235-9

3. Al-Jabir, A., Kerwan, A., Nicola, M., Alsafi, Z., Khan, M., Sohrabi, C., et al. (2020). Impact of the Coronavirus (COVID-19) pandemic on surgical practice — Part 2 (surgical prioritisation). International journal of surgery (London, England), 79, 233–248. https://doi.org/10.1016/j.ijsu.2020.05.002

4. Moletta, L., Pierobon, E. S., Capovilla, G., Costantini, M., Salvador, R., Merigliano, S., et al. (2020). International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. International journal of surgery (London, England), 79, 180–188. https://doi.org/10.1016/j.ijsu.2020.05.061

5. COVIDSurg Collaborative (2020). Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet (London, England), 396(10243), 27–38. https://doi.org/10.1016/S0140-6736(20)31182-X

6. American College of Surgeons. COVID-19 Guidelines for Triage of Vascular Surgery Patients. Accessed in April, 2020 in https://www.facs.org/covid-19/clinical-guidance/elective-case/vascular-surgery

7. Rede de Referenciação Hospitalar – Angiologia e Cirurgia Vascular. Acessed in April, 2020 in https://www.sns.gov.pt/wp-content/uploads/2017/05/RRH-Angiologia-e-Cirurgia-Vascular-Para-CP.pdf

8. Ng, J. J., Ho, P., Dharmaraj, R. B., Wong, J., & Choong, A. (2020). The global impact of COVID-19 on vascular surgical services. Journal of vascular surgery, 71(6), 2182–2183.e1. https://doi.org/10.1016/j.jvs.2020.03.024

9. Valdivia, A. R., Sanus, E. A., Santos, Á. D., Olmos, C. G., Alguacil, S. G., Amrani, M., et al. (2020). Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid. Annals of vascular surgery, 67, 1–5. Advance online publication. https://doi.org/10.1016/j.avsg.2020.06.001

10. Ben Abdallah I. (2020). Early experience in Paris with the impact of the COVID-19 pandemic on vascular surgery. Journal of vascular surgery, 72(1), 373. https://doi.org/10.1016/j.jvs.2020.04.467

11. Leong Tan, G. W., Chandrasekar, S., Lo, Z. J., Hong, Q., Yong, E., Lingam, P., et al. (2020). Early experience in the COVID-19 pandemic from a vascular surgery unit in a Singapore tertiary hospital. Journal of vascular surgery, 72(1), 12–15. https://doi.org/10.1016/j.jvs.2020.04.014

12. Schuivens, P., Buijs, M., Boonman-de Winter, L., Veen, E. J., de Groot, H., Buimer, T. G., et al. (2020). Impact of the COVID-19 lock down strategy on vascular surgery practice: more major amputations than usual. Annals of vascular surgery, S0890-5096(20)30617–8. Advance online publication. https://doi.org/10.1016/j.avsg.2020.07.025

13. Sena, G., & Gallelli, G. (2020). An increased severity of peripheral arterial disease in the COVID-19 era. Journal of vascular surgery, 72(2), 758. https://doi.org/10.1016/j.jvs.2020.04.489

14. Mowbray, N. G., Ansell, J., Horwood, J., Cornish, J., Rizkallah, P., Parker, A., et al. (2020). Safe management of surgical smoke in the age of COVID-19. The British journal of surgery, 10.1002/bjs.11679. Advance online publication. https://doi.org/10.1002/bjs.11679
Published
2021-09-10
Section
Original Article

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