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Differences in hub and spoke vascular units practice during the novel Coronavirus-19 (COVID-19) outbreak in Lombardy,
Raffaello Bellosta1, Daniele Bissacco2, Giovanni Rossi3
1Unit of Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy.
Insights
Vascular surgery units in hub and spoke hospitals provided similar results during COVID-19. However, both settings saw poor outcomes due to COVID-19 pneumonia, highlighting its impact on vascular disease patients.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Health Services Research
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery, necessitating an evaluation of clinical practices in vascular surgery.
- Differences in clinical practice between referral (hub) and satellite (spoke) hospital vascular surgery units (VSUs) during the initial phase of the COVID-19 pandemic in Lombardy were examined.
Purpose of the Study:
- To compare clinical practices and patient outcomes between hub (HH) and spoke (SH) hospital vascular surgery units.
- To identify predictors of poor outcomes in vascular surgery patients during the COVID-19 pandemic.
Main Methods:
- A retrospective analysis of the Vascular Surgery Group of Regione Lombardia Register was conducted.
- Data from 659 vascular patients admitted between March 8 and May 3, 2020, were analyzed, comparing outcomes between HH and SH cohorts.
- Primary endpoint was 30-day mortality; secondary outcomes included complications and amputation rates for peripheral artery disease (PAD).
Main Results:
- No significant difference in COVID-19 positivity rates was observed between HH and SH (21.7% vs. 15.9%).
- Similar 30-day mortality and non-intervention-related complication rates were found in both groups (12.1% vs. 10.0% and 10.3% vs. 8.3%, respectively).
- Hub hospitals reported higher postoperative complications (23.4% vs. 16.9%) but lower amputation rates for PAD (10.8% vs. 26.8%) compared to spoke hospitals.
Conclusions:
- Both hub and spoke hospitals demonstrated comparable results for vascular disease patients during the early COVID-19 pandemic.
- COVID-19 infection and related pneumonia were identified as independent predictors of mortality and postoperative complications across both settings.
- Despite comparable overall outcomes, specific complications like postoperative issues and amputations varied between hub and spoke models.
Background:
To highlight differences in clinical practice among referral (hub, HH) or satellite (spoke, SH) hospital vascular surgery units (VSUs) in Lombardy, during the COVID-19 pandemic "phase 1" period (March 8 - May 3, 2020).
Methods:
The Vascular Surgery Group of Regione Lombardia Register, a real-word, multicenter, retrospective register was interrogated. All patients admitted with vascular disease were included. Patients' data on demographics, COVID-19 positivity, comorbidities and outcomes were extrapolated. Two cohorts were obtained: patients admitted to HH or SH. Primary endpoint was 30-day mortality rate. Secondary outcomes were 30-day complications and amputation (in case of peripheral artery disease [PAD]) rates. Univariate and multivariate analysis were used to compare HH and SH groups and predictors of poor outcomes.
Results:
During the study period, 659 vascular patients in 4 HH and 27 SH were analyzed. Among these, 321 (48.7%) were admitted to a HH. No difference in COVID-19 positive patients was described (21.7% in HH vs. 15.9% in SH; P=0.058). After 30 days from intervention, HH and SH experienced similar mortality and no-intervention-related complication rate (12.1% vs. 10.0%; P=0.427 and 10.3% vs. 8.3%; P=0.377, respectively). Conversely, in HH postoperative complications were higher (23.4% vs. 16.9%, P=0.038) and amputations in patients treated for PAD were lower (10.8% vs. 26.8%; P<0.001) than in SH. Multivariate analysis demonstrated in both cohorts COVID-19-related pneumonia as independent predictor of death and postoperative complications, while age only for death.
Conclusions:
HH and SH ensured stackable results in patients with vascular disease during COVID-19 "phase 1." Despite this, poor outcomes were observed in both HH and SH cohorts, due to COVID-19 infection and its related pneumonia.
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