Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Abstract

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak.

Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume.

Results: The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence.

Conclusion: Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Keywords: AAA; COVID-19; PAD; Survey; Vascular surgery.

Figure 2

Overall relative mean reductions in service throughout the study period. Results of the service reduction scores for all European (including UK for the purposes of this analysis, which remained in the transition period until December 2020) centres represented in the survey (purple), continental Europe alone (blue), and the UK (red). Each grey dot represents a centre response.

Figure 1

Reported change in the number of inpatient dedicated vascular beds during the survey period. A negative number on the y axis indicates a drop in the number of beds compared with the centre's baseline. The smoothed line (blue) represents mean changes over five days to demonstrate the overall change. The responses suggest that bed levels for vascular patients has not returned to baseline by the end of the survey period.

Figure 3

Reported estimated waiting list figures for key vascular conditions and associated surgery. Figures were taken from centres that had access to their waiting lists. The x axis represents the estimated number of patients on the waiting list for each procedure. The y axis indicates the percentage of responding centres in each category. (A) Abdominal aortic aneurysm repair. (B) Open surgery for peripheral arterial disease. (C) Endovascular procedure for peripheral arterial disease. (D) Treatment for varicose vein treatment.