Is it Possible to Safely Maintain a Regular Vascular Practice During the COVID-19 Pandemic?

Abstract

Objective: This study aimed to evaluate the protocol adopted during the emergency phase of the COVID-19 pandemic to maintain elective activity in a vascular surgery unit while minimising the risk of contamination to both patients and physicians, and the impact of this activity on the intensive care (IC) resources.

Methods: The activity of a vascular surgery unit was analysed from 8 March to 8 April 2020. Surgical activity was maintained only for acute or elective procedures obeying priority criteria. The preventive screening protocol consisted of nasopharyngeal swabs (NPS) for all patients and physicians with symptoms and for unprotected contact infected cases, and serological physician evaluations every 15 days. Patients treated in the acute setting were considered theoretically infected and the necessary protective devices were used. The number of patients and the possible infection of physicians were evaluated. The number and type of interventions and the need for post-operative IC during this period were compared with those in the same periods in 2018 and 2019.

Results: One hundred and fifty-one interventions were performed, of which 34 (23%) were acute/emergency. The total number of interventions was similar to those performed in the same periods in 2019 and 2018: 150 (33, of which 22% acute/emergency) and 117 (29, 25% acute/emergency), respectively. IC was necessary after 6% (17% in 2019 and 20% in 2018) of elective operations and 33% (11) of acute/emergency interventions. None of the patients treated electively were diagnosed with COVID-19 infection during hospitalisation. Of the 34 patients treated in acute/emergency interventions, five (15%) were diagnosed with COVID-19 infection. It was necessary to screen 14 (47%) vascular surgeons with NPS after contact with infected colleagues, but none for unprotected contact with patients; all were found to be negative on NPS and serological evaluation.

Conclusion: A dedicated protocol allowed maintenance of regular elective vascular surgery activity during the emergency phase of the COVID-19 pandemic, with no contamination of patients or physicians and minimal need for IC resources.

Keywords: COVID-19; Regular practice; Surgery; Vascular surgery.

Figure 1

Spread of infection of SARS-CoV-2 in the Emilia-Romagna region of Italy in February–April 2020. (A) Rise in infections, deaths, and recoveries in Emilia-Romagna and (B) geographical location of infections in Emilia-Romagna and other regions in Italy; panels modified from Ref.. (C) Percentage of patients with COVID-19 in relation to intensive care unit (ICU) availability in different regions in Italy.

Figure 2

(A) Geographical location of Emilia Romagna region in Italy and (B) Bologna hospitals locations; panels modified from www.google.com/maps/@41.5453707,12.1086237,6z?hl=it and www.google.com/maps/@44.4531805,11.1198542,10z?hl=it, respectively (last accessed 10 April 2020).

Figure 3

(A) Fast track preparation area for COVID-19 patient acute/emergency vascular surgery and (B, C, D) pre-emptive isolation of hybrid room devices for COVID-19 patient acute/emergency intervention in Emilia-Romagna region, Italy, in 2020.

Figure 4

Flow chart for serological evaluation for immunoglobulins M and G (IgM and IgG) of vascular surgeons and further use of nasopharyngeal swabs (NPS) during pandemic COVID-19 infection in Emilia-Romagna region, Italy, from 8 March to 8 April in 2020.

Figure 5

Percentage of elective endovascular interventions from all vascular interventions in Emilia-Romagna region, Italy, from 8 March to 8 April during pandemic COVID-19 infection in 2020 and in years 2018 and 2019.