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. 2021 Mar;36(3):848-856.
doi: 10.1111/jocs.15307. Epub 2021 Jan 13.

Early experience of aortic surgery during the COVID-19 pandemic in the UK: A multicentre study

Ana Lopez-Marco  1 , Amer Harky  2   3   4   5 , Danilo Verdichizzo  6 , Emma Hope  7 , Barbara Rosser  8 , Iain McPherson  9 , Ronan Kelly  10 , Luke Holland  11 , Aung Ye Oo  1 ; UK AS Research Group
Affiliations

Early experience of aortic surgery during the COVID-19 pandemic in the UK: A multicentre study

Ana Lopez-Marco et al. J Card Surg. 2021 Mar.

Abstract

Background: A significant restructuring of the healthcare services has taken place since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, with elective surgery put on hold to concentrate intensive care resources to treat COVID-19 as well as to protect patients who are waiting for relatively low risk surgery from exposure to potentially infected hospital environment.

Methods: Multicentre study, with 19 participating centers, to define the impact of the pandemic on the provision of aortovascular services and patients' outcomes after having adapted the thresholds for intervention to guarantee access to treatment for emergency and urgent conditions. Retrospective analysis of prospectively collected data, including all patients with aortovascular conditions admitted for surgical or conservative treatment from the 1st March to the 20th May 2020.

Results: A total of 189 patients were analyzed, and 182 underwent surgery. Diagnosis included: aneurysm (45%), acute aortic syndrome (44%), pseudoaneurysm (4%), aortic valve endocarditis (4%), and other (3%). Timing for surgery was: emergency (40%), urgent (34%), or elective (26%). In-hospital mortality was 12%. Thirteen patients were diagnosed with COVID-19 during the peri-operative period, and this subgroup was not associated with a higher mortality.

Conclusions: There was a significant change in service provision for aortovascular patients in the UK. Although the emergency and urgent surgical activity were maintained, elective treatment was minimal during early months of the pandemic. The preoperative COVID-19 screening protocol, combined with self-isolation and shielding, contributed to the low incidence of COVID-19 in our series and a mortality similar to that of pre-pandemic outcomes.

Keywords: aorta; aortic dissection; aortic surgery; pandemic.

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Conflict of interest statement

All the authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Temporal varitation in the delivery of aortovascular services. Surgical activity displayed weekly including total number of cases (blue line) and grouped by timing of the operation: elective (orange line), urgent (gray line), and/or emergency (yellow line). The vertical green arrow marks the start of the lockdown situation in the UK. There was a clear reduction of surgical activity after the start fo the lockdown, with almost disappearance of the elective surgical activity during the first months of the pandemic in the UK
Figure 2
Figure 2
Temporal variation in the mortality of patients with aortovacular conditions treated in the participating centers in the UK over the COVID‐19 pandemic period. The vertical green arrow marks the start of the lockdown situation in the UK. The blue line displays weekly mortality from aortovascular conditions compared to the the total number of aortovacualr conditions treated in the same period in the participating centers (orange line). Note that the mortality trend for aortovascular conditions was constant during the early months of the pandemic in the UK
Figure 3
Figure 3
Geographical variation in the presentation of aortovascular conditions to hospital during the study period in the 19 participating centers in the UK. The different UK maps display the overall admissions (blue) as well as per level of emergency: elective cases (green), urgent cases (yellow), and emergency cases (orange). The graded colors represent the number of patients with aortovascular ondictions admitted to hospital for assessment and/or surgical treatment according each geographical region. The areas displayed in gray were the regions covered by centers not contributing to the study
Figure 4
Figure 4
Graph showing the trend in mortality due to coronavirus disease 2019 (COVID‐19) in the UK displayed weekly (blue line) and the surgical aortovascular mortality during the same period of time in the study participating centers (orange line). The lines cross‐over on the week of the 16 March 2020, corresponding with the start of the lockdown in the UK, when the number of COVID‐19 cases started to increase exponentially and the Aortovascular activity decreased initially due to the reduced presentation to hospitals. Both curves reached a peak around mid of April to descend in a parallel way after that. Note that he scale for the COVID‐19 mortality has been adapted and has to be multiplied ×100
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References

    1. Cai Y, Hao Z, Gao Y, et al. Coronavirus disease 2019 in the perioperative period of lung resection: a brief report from a single thoracic surgery department in Wuhan, People's Republic of China. J Thorac Oncol. 2020;15(6):1065‐1072. - PMC - PubMed
    1. World Health Organization . WHO announces COVID‐19 outbreak a pandemic. WHO; 2020. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-...
    1. NHS England. Next Step on NHS Response to COVID‐19. 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/...
    1. Barts Protocol for Surgery in Aortovascular patients during the COVID‐19 Pandemic. https://www.scts.org. Published online April 2, 2020.
    1. COVID‐19: Guidance for Triage of Non‐Emergence Surgical Procedures. American College of Surgeons. https://www.facs.org. Published online March 17, 2020.