Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery

Abstract

Background The novel Coronavirus Disease 2019 (COVID-19) pandemic is having a profound impact on global healthcare. Shortages in staff, operating theatre space and intensive care beds has led to a significant reduction in the provision of surgical care. Even vascular surgery, often insulated from resource scarcity due to its status as an urgent specialty, has limited capacity due to the pandemic. Furthermore, many vascular surgical patients are elderly with multiple comorbidities putting them at increased risk of COVID-19 and its complications. There is an urgent need to investigate the impact on patients presenting to vascular surgeons during the COVID-19 pandemic. Methods and analysis The COvid-19 Vascular sERvice (COVER) study has been designed to investigate the worldwide impact of the COVID-19 pandemic on vascular surgery, at both service provision and individual patient level. COVER is running as a collaborative study through the Vascular and Endovascular Research Network (VERN), an independent, international vascular research collaborative with the support of numerous national and international organisations). The study has 3 ‘Tiers’: Tier 1 is a survey of vascular surgeons to capture longitudinal changes to the provision of vascular services within their hospital; Tier 2 captures data on vascular and endovascular procedures performed during the pandemic; and Tier 3 will capture any deviations to patient management strategies from pre-pandemic best practice. Data submission and collection will be electronic using online survey tools (Tier 1: SurveyMonkey® for service provision data) and encrypted data capture forms (Tiers 2 and 3: REDCap® for patient level data). Tier 1 data will undergo real-time serial analysis to determine longitudinal changes in practice, with country-specific analyses also performed. The analysis of Tier 2 and Tier 3 data will occur on completion of the study as per the pre-specified statistical analysis plan.

The effects of COVID-19 pandemic on patients with lower extremity peripheral arterial disease: A near miss disaster

“…Moreover, our findings suggest that patients with PAD were probably less likely to seek medical contact and tended to manage pharmacological treatment independently. These aspects are in line with previous reports and studies both in the setting of vascular surgery [ 24 , 25 ], and other specialties [26] , [27] , [28] . These results highlight a need to maintain the expertise and resources to provide appropriate and safe care of PAD patients, during a pandemics as also suggested by other colleagues [29] .…”

“…Even if absolute numbers are substantially low in our study, they could translate into a catastrophic scenario if extended on a large scale. Consistently, the COVER project, analyzing the impact of COVID-19 pandemic on provision, practice, and outcomes of vascular surgery, has reported changes in the management of PAD patients during the pandemic, with a majority of participating units performing a higher proportion of major amputation or palliative care rather than attempting revascularization for chronic limb threatening ischemia [24] . In our study, this dramatic situation was partially mitigated by the organization of our center, which allowed us to maintain some semi-elective surgical activity twice a week in addition to the emergency rooms.…”

“…The 2020 lockdown not only impacted access to surgery but also the type of surgery performed. In fact, 60% of vascular units in the COVER project documented a shift towards an endovascular-first treatment strategy, especially in chronic PAD Fontaine stages III and IV [24] . In our study, the proportion of open, endovascular, and hybrid procedures were not significantly different between 2020 and 2018-2019.…”

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

“…Reports from Massachusetts observe a decline in procedures between 18 March 2020 and the end of the year, even after resumption of normal services ( 10 ). Initiatives like the Vascular Surgery COVID-19 Collaborative (VASCC) ( 11 ) and the COVID-19 Vascular Service (COVER) study ( 12 ) will hopefully further elucidate the impact of de SARS-CoV-2 pandemic on vascular practices worldwide.…”

Impacto da COVID-19 no perfil cirúrgico dos pacientes de cirurgia vascular em serviço de referência em Curitiba

“…It became necessary to weigh the risk of the patient contracting the virus against the risk of the patient developing devastating complications of the underlying vascular diseases. 8 …”