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Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited
Abul Hasan Muhammad Bashar1, Md Enamul Hakim2, Md Mokhlesur Rahman1
1Department of Vascular Surgery, National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh.
Insights
A new guideline for vascular surgeons in Bangladesh during the COVID-19 pandemic effectively managed emergency vascular care. The adapted approach ensured caregiver safety while maintaining comparable treatment outcomes despite resource constraints.
Area of Science:
- Vascular Surgery
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally, particularly in developing nations like Bangladesh.
- Limited resources and high patient volumes posed challenges for vascular surgeons providing essential services.
- The National Institute of Cardiovascular Diseases and Hospital, Dhaka, recognized the need for a tailored guideline to navigate this crisis.
Purpose of the Study:
- To develop and implement a working guideline for vascular surgeons in Bangladesh during the COVID-19 pandemic.
- To safeguard healthcare professionals while ensuring the continuity of emergency vascular care.
- To adapt existing practices to a high-volume, resource-constrained environment.
Main Methods:
- A total of 307 emergency vascular patients were managed under the new guideline over four months (March-June 2020).
- Patient outcomes were compared to the four months preceding the pandemic.
- Vascular healthcare workers underwent regular COVID-19 screening.
Main Results:
- A 38% decrease in patient numbers was observed during the COVID-19 period.
- Treatment outcomes were comparable to pre-pandemic levels, with a noted increase in limb loss for chronic limb-threatening ischemia patients.
- COVID-19 infection rates among vascular healthcare professionals remained low.
Conclusions:
- The customized vascular surgery guidelines were effective in providing emergency care during the COVID-19 pandemic in Bangladesh.
- The guideline successfully ensured the safety of healthcare providers.
- These adapted guidelines remain relevant for developing countries facing similar public health crises.
Background:
The situation of coronavirus disease 2019 (COVID-19) pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the health care sector makes the fight against COVID-19 more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, have developed a working guideline for our vascular surgeons to follow during the COVID-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country.
Methods:
A total of 307 emergency vascular patients were dealt with in the first 4 COVID-19 months (March through June 2020) according to the working guideline, and the results were compared with the 4 pre-COVID-19 months. Vascular trauma, dialysis access complications, and chronic limb-threatening ischemia formed the main bulk of the patient population. Vascular health care workers were regularly screened for COVID-19 infection.
Results:
There was a 38% decrease in the number of patients in the COVID-19 period. Treatment outcome in COVID-19 months were comparable with that in the pre-COVID-19 months except that limb loss in the chronic limb-threatening ischemia patients was higher. COVID-19 infection among the vascular health care professionals was low.
Conclusions:
Vascular surgery practice guidelines customized for the high work volume and limited resources of the National Institute of Cardiovascular Diseases and Hospital, Dhaka were effective in delivering emergency care during COVID-19 pandemic, ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening COVID-19 crisis in a developing country like Bangladesh.
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