Lessons Learned from the Impact of the COVID-19 Pandemic in a Vascular Surgery Department and Preparation for Future Outbreaks

Abstract

Objectives: This study aims to report the changes and adaptations of a vascular tertiary center during a global pandemic and the impact on its activity and patients. Methods: We conducted a retrospective cohort study within the Vascular Surgery ward in Centro Hospitalar Universitário Lisboa Nor te, Por tugal. All data from surgical, inpatient and outpatient activity were collected from February to June 2020 and compared to the same 5-month period in 2018 and 2019. We ran a descriptive analysis of all data and performed statistical tests for the variation of procedures and admissions between February and June 2018 and the same time period in 2020. Results: During the outbreak, our staff had to be readapted. Six nurses were transferred to COVID-19 units (out of a total of 33 nurses) while 1 of the 7 residents was transferred to an intensive care unit and 1 senior surgeon was put on prophylactic leave. In the outpatient clinic, there was an increase in the number of telemedicine consultations with a greater focus on first-time referrals and urgent cases. There was a significant increase in the total number of elective admissions whereas there were significantly less admissions from an emergency setting ( + 57% and −54%, respectively, P < 0.001). The vascular surgery team performed a total number of 584 procedures between February and June 2020 ( −17.8% compared to 2018 and 2019), with a significant increase in the number of endovascular procedures ( P < 0.001) and in the use of local and regional anesthesia ( P < 0.001), especially in the Angio Suite ( + 600%, P < 0.001). Comparing with 2018 and 2019, the surgical team performed less outpatient procedures in early 2020. We reported a significant increase in the total number of procedures for patients with a chronic limb-threatening ischemia (CLTI) diagnosis ( + 21%, P < 0.001). We did not report significant changes in the proportion of other vascular conditions. Regarding mortality, we observed a 16% decrease in the intraoperative mortality ( P 0.67).

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

“…Duarte A et al retrospectively reviewed VS cases from February to June 2020, and found that compared to a similar period in 2018, the VS team performed 17.8% less procedures. 29 Similar to most institutions, Gouveia E Melo R et al reported deferment of all non-urgent elective cases and continuation of time-sensitive cases such as CLTI, symptomatic CAS or AAA > 5.5 cm. 30 …”

“… 10 Similarly, Duarte A et al and Boschetti GA et al both reported a 54% and 40.5% reduction in patients presenting via the emergency department respectively. 23 , 29 Ben Abdallah I et al also reported an overall decrease in vascular referrals. 31 Lastly, specific to CLTI, Mascia D et al reported a 50% reduction in patients presenting with ruptured or symptomatic AAA, suggesting a possible delay or lack of presentation for aortic conditions .…”

“…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.…”

“…A total of 13 articles originated from Europe which had described the change in provision of VS surgical services during the COVID-19 pandemic. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 Six articles were from Italy, three articles were from Portugal, and four articles were from France, Ireland, Turkey and Germany respectively. All six articles from Italy described continuation of emergency VS cases and only selected time-sensitive elective cases in March-April 2020, which corresponded to a lockdown period.…”

“…Duarte A et al also reported a 27.1% increase in the use of only local anaesthesia during the COVID-19 pandemic. 29 Gouveia E Melo et al, Ben Abdallah et al, Connolly et al, and EU Ünal et al have also recommended the use of more endovascular techniques and locoregional anaesthesia, although they did not provide any descriptive data. 30 , 31 , 32 , 34 …”