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Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid
Andrés Reyes Valdivia1, Enrique Aracil Sanus1, África Duque Santos1
1Department of Vascular and Endovascular Surgery, Ramón y Cajals University Hospital, Madrid, Spain.
Insights
The COVID-19 pandemic significantly altered vascular surgery practices, prioritizing urgent procedures and adapting to resource limitations. This shift impacted patient care and surgical decision-making in affected regions.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic presents a global health crisis with significant implications for patient care.
- Vascular patients are at higher risk for severe COVID-19 due to comorbidities.
- Healthcare systems worldwide have faced unprecedented challenges in managing surgical services during the pandemic.
Purpose of the Study:
- To describe the impact of the COVID-19 outbreak on daily vascular surgery practice.
- To analyze changes in surgical procedures, organization, and outcomes.
- To identify challenges encountered in vascular surgery during the pandemic.
Main Methods:
- Observational study design.
- Analysis of surgical practice over a two-month period during lockdown in Madrid, Spain.
- Description of procedural changes, organizational adjustments, and encountered difficulties.
Main Results:
- Vascular surgery was reduced to urgent and semi-urgent cases only.
- Critical limb ischemia was the primary indication for surgery (60%).
- Significant organizational changes included altered surgical room allocation and staffing, impacting decision-making.
Conclusions:
- The COVID-19 pandemic necessitated a dramatic shift towards urgent surgical care in vascular surgery.
- Limited hospital resources, including ICU beds and nursing staff, critically influenced surgical practice and decision-making.
- Adaptation of vascular surgery services is crucial for maintaining patient care during public health emergencies.
Background:
The epidemic potential of coronavirus infection is now a reality. Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease because of its nature associating several comorbid states, and thus, some vascular surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times.
Methods:
This is an observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spain-one of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14th when the lockdown was declared up to date, May 14th (2 months). Procedural surgical practice, organizational issues, early outcomes, and all the troubles encountered during this new situation are described.
Results:
Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the period. Five surgeries were performed on 3 COVID-19-positive patients. Sixty percent were due to critical limb ischemia, 45% of them performed by complete endovascular approach, whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff.
Conclusions:
The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semiurgent surgical care alone. The lack of in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision-making in some cases.
