Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;61(2):306-315.
doi: 10.1016/j.ejvs.2020.10.025. Epub 2020 Nov 13.

Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients

Andrea Kahlberg  1 , Daniele Mascia  2 , Raffaello Bellosta  3 , Luca Attisani  3 , Matteo Pegorer  3 , Anna M Socrate  4 , Matteo Ferraris  4 , Piero Trabattoni  5 , Enrico Rinaldi  2 , Andrea Melloni  2 , Fabrizio Monaco  6 , Germano Melissano  2 , Roberto Chiesa  2
Affiliations

Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients

Andrea Kahlberg et al. Eur J Vasc Endovasc Surg. 2021 Feb.

Abstract

Objective: During the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing.

Methods: Data from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs.

Results: Among 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs.

Conclusion: During the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events.

Keywords: Covid-19; Limb ischaemia; Lombardy; Pandemics; SARS-CoV-2; Vascular surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Map of Lombardy, Italy, showing identified Hub hospitals for vascular surgery in Lombardy region during COVID-19 epidemic, and referring Spoke hospitals.
See this image and copyright information in PMC

Comment in

References

    1. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J. China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–733. - PMC - PubMed
    1. COVID-19 dashboard by the center for systems science and engineering (CSSE) at Johns Hopkins university (JHU). ArcGIS. Johns Hopkins University. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594... [Accessed 1 June 2020].
    1. Regional Authority of Lombardy (Regione Lombardia). DELIBERAZIONE N° XI/2906 Seduta del 08/03/2020. Available at: https://www.regione.lombardia.it/wps/wcm/connect/5e0deec4-caca-409c-825b.... [Accessed 28 October 2020].
    1. Wanhainen A., Verzini F., Van Herzeele I., Allaire E., Bown M., Cohnert T. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57:8–93. - PubMed
    1. Behrendt C.A., Bertges D., Eldrup N., Beck A.W., Mani K., Venermo M. International Consortium of vascular Registries consensus recommendations for peripheral revascularisation registry data collection. Eur J Vasc Endovasc Surg. 2018;56:217–237. - PubMed

MeSH terms