Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic

Ng, Jun Jie; Gan, Tiffany Rx; Niam, Jen Yong; Menon, Raj; Ho, Pei; Dharmaraj, Rajesh Babu; Wong, Julian C.L.; Choong, Andrew M.T.L.

doi:10.1016/j.jvs.2020.05.026

Cited by 14 publications

(21 citation statements)

References 8 publications

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“…Similar COVID-19–driven practice restructuring has been reported from a tertiary hospital in Singapore. 11 The present guideline although fundamentally in line with these previously published principles is based on the unique situation in Bangladesh. We have taken into account the availability of not only vascular surgeons but also the supporting staff including anesthesiologists and those who have access to the OT and catheterization laboratories.…”

Section: Discussionmentioning

confidence: 77%

“…The previously mentioned strategy is fundamentally different from that pursued in the developed countries. 10 , 11 Realizing the pitfalls of this strategy, the government of Bangladesh has now changed its policy to accommodate patients both with COVID-19 and without COVID-19 in the same facility. 12 However, it is still not clear how effective this will be in delivering patient care without compromising safety.…”

Section: Discussionmentioning

confidence: 99%

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Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country

Bashar

Hakim

Rahman

et al. 2021

Annals of Vascular Surgery

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Background The situation of coronavirus disease 2019 (COVID-19) pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the health care sector makes the fight against COVID-19 more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, have developed a working guideline for our vascular surgeons to follow during the COVID-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country. Methods A total of 307 emergency vascular patients were dealt with in the first 4 COVID-19 months (March through June 2020) according to the working guideline, and the results were compared with the 4 pre–COVID-19 months. Vascular trauma, dialysis access complications, and chronic limb-threatening ischemia formed the main bulk of the patient population. Vascular health care workers were regularly screened for COVID-19 infection. Results There was a 38% decrease in the number of patients in the COVID-19 period. Treatment outcome in COVID-19 months were comparable with that in the pre–COVID-19 months except that limb loss in the chronic limb-threatening ischemia patients was higher. COVID-19 infection among the vascular health care professionals was low. Conclusions Vascular surgery practice guidelines customized for the high work volume and limited resources of the National Institute of Cardiovascular Diseases and Hospital, Dhaka were effective in delivering emergency care during COVID-19 pandemic, ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening COVID-19 crisis in a developing country like Bangladesh.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country

Bashar

Hakim

Rahman

et al. 2021

Annals of Vascular Surgery

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“…A total of 19 articles had reported changes in the conduct of emergency and elective VS cases in respective institutions. 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 In summary, all articles reported continuation of emergency VS cases such as ruptured AAAs, and deferment of non-urgent elective VS cases such as revascularization for claudicants and varicose veins. There was some inter-institutional variation between the type of VS cases that proceeded or were deferred.…”

Section: Resultsmentioning

confidence: 95%

“… 26 Ng JJ et al had also reported an increase in major amputation rates from 2.5% of all VS cases performed in November and December 2019 combined, to 4.2% of all VS cases performed in January to March 2020 combined. 37 Boschetti GA and Mascia D et al both reported more patients presenting late with limb ischaemia. 23 , 27 Lastly, Bashar AHM et al similarly reported a decrease in limb salvage rate from 83.6% to 72.4% for patients presenting with CLTI during the COVID-19 pandemic compared to a pre-pandemic period.…”

Section: Resultsmentioning

confidence: 97%

“…Both Leong Tan GW et al, and Ng JJ et al had describe institutional and VS unit changes early in the COVID-19 pandemic in Singapore. 36 , 37 Both authors described deferment of elective non-urgent VS cases, and only continuation of more urgent elective cases such as revascularization for CLTI patients. Bashar AHM et al provided an insight into the conduct of VS cases during the COVID-19 pandemic.…”

Section: Resultsmentioning

confidence: 99%

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A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic

Lee

Ranganathan

Choong

et al. 2021

Seminars in Vascular Surgery

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Objective : The COVID-19 pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgeries. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. Methods : We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. Results : A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anaesthesia, delayed presentation of vascular surgery conditions and poorer outcomes of patients with chronic limb-threatening ischaemia. Conclusions : This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.

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Treating Peripheral Arterial Occlusive Disease and Acute Limb Ischemia During a COVID-19 Pandemic in 2020

Exelmans

Knaapen

Winter

et al. 2022

Annals of Vascular Surgery

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Objective For many surgeons the outbreak of SARS-CoV-2 meant a downscaling of surgical interventions. The aim of this study was to investigate the impact of the measures taken on the care for patients with peripheral arterial disease (PAOD) and acute limb ischemia (ALI). Methods A retrospective analysis of the vascular practices of two major teaching hospitals in the Netherlands was performed. All interventions and outpatient visits for PAOD or ALI in 2020 were included. Patients treated in 2018 and 2019 were to serve as a control group. Data were analysed using descriptive statistics. Results In 2020, a total of 1513 procedures were performed for PAOD or ALI. This did not differ significantly from previous years. Overall, Fontaine 2 and 4 were the most frequent indications for intervention. A significant increase in the number of major amputations was observed in 2020 compared to 2018 (p <0.01). This was mainly due to patients suffering from PAOD Fontaine 4. Inversely, a reduction in the number of femoro-popliteal bypasses was observed between 2020 and 2018. The number of outpatient visit due to Fontaine 2 was significantly lower in 2020 compared to 2018. Conclusion The vascular practices of our hospitals were minimally influenced by the measures taken due to the outbreak of SARS-CoV-2. There was an increase in the number of amputation but an enormous surge in patients presenting with critical limb ischemia was not observed.

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Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic

Cited by 14 publications

References 8 publications

Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country

Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country

A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic

Treating Peripheral Arterial Occlusive Disease and Acute Limb Ischemia During a COVID-19 Pandemic in 2020

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