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 May:73:97-106.
doi: 10.1016/j.avsg.2021.01.060. Epub 2021 Jan 22.

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

António Duarte  1 , Ryan Gouveia E Melo  2 , Alice Lopes  3 , João Pedro Rato  3 , João Valente  4 , Luís Mendes Pedro  2
Affiliations

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

António Duarte et al. Ann Vasc Surg. 2021 May.

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 Norte, Portugal. 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).

Conclusions: In this study, we assessed the impact of the COVID-19 outbreak in daily activity during the contingency period. During the outbreak, there was an overall decline in outpatient clinics and inpatient admissions. Nevertheless, and despite the restrictions imposed by the pandemic and health authorities, we managed to maintain most procedures for most vascular diseases, particularly for CLTI urgent cases, without a significant increase in the mortality rate. Stringent protective measures for patient and staff or higher use of endovascular techniques and local anesthesia are some of the successful changes implemented in the department. These learned lessons are to be pursued as the pandemic evolves with future outbreaks of COVID-19, such as the current second outbreak currently spreading through Europe.

PubMed Disclaimer

Figures

Fig. 1:
Fig. 1
COVID-19 outbreak timeline. (A) Timeline representing events worldwide (blue circles) and in Portugal (yellow circles); (B)Timeline representing the changes in the vascular surgery department. (Color version of figure is available online.)
Fig. 2:
Fig. 2
Number of surgical procedures per clinical diagnosis between 2018 and 2020. ALI, acute limb ischemia; PAD, peripheral arterial disease; CLTI, chronic limb-threatening ischemia.
Fig. 3:
Fig. 3
Changes in surgical activity during the COVID-19 outbreak: variation of vascular procedures during the outbreak (bar chart) over the variation of new COVID-19 cases worldwide (blue line) and new COVID-19 cases in Portugal (orange line). Source: World Health Organization data table, https://covid19.who.int/table (as of August 25, 2020); ALI, acute limb ischemia; PAD, peripheral arterial disease. (Color version of figure is available online.)
See this image and copyright information in PMC

References

    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. Gouveia e Melo R, Pedro LM. Vascular surgery department adjustments in the era of the COVID-19 pandemic. J Vasc Surg. 2020;72:375–376. doi: 10.1016/j.jvs.2020.04.017. - DOI - PMC - PubMed
    1. Hemingway JF, Singh N, Starnes BW. Emerging practice patterns in vascular surgery during the COVID-19 pandemic. J Vasc Surg. 2020;72:396–402. doi: 10.1016/j.jvs.2020.04.492. - DOI - PMC - PubMed
    1. Li W, Chen X, Feng H. Impact of COVID-19 on peripheral arterial disease treatment. Ann Vasc Surg. 2020;67:6–7. doi: 10.1016/j.avsg.2020.05.045. - DOI - PMC - PubMed
    1. Schuivens PME, Buijs M, Boonman-de Winter L, et al. Impact of the COVID-19 lockdown strategy on vascular surgery practice: more major amputations than usual. Ann Vasc Surg. 2020;69:74–79. doi: 10.1016/j.avsg.2020.07.025. - DOI - PMC - PubMed

MeSH terms