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Early experience of aortic surgery during the COVID-19 pandemic in the UK: A multicentre study
Ana Lopez-Marco1, Amer Harky2,3,4,5, Danilo Verdichizzo6
1Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
Insights
The COVID-19 pandemic significantly altered aortovascular services, prioritizing emergency and urgent surgeries. Preoperative screening and isolation protocols helped maintain low mortality rates for these vascular patients.
Area of Science:
- Vascular Surgery
- Public Health
- Infectious Disease Epidemiology
Background:
- The COVID-19 pandemic necessitated major healthcare restructuring, including pausing elective surgeries.
- Intensive care resources were reallocated for COVID-19 patients.
- Patient safety was a concern due to potential exposure in hospital settings.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on aortovascular services and patient outcomes.
- To evaluate changes in surgical intervention thresholds during the pandemic.
- To analyze treatment provision for emergency and urgent aortovascular conditions.
Main Methods:
- A multicentre retrospective analysis of prospectively collected data from 19 centers.
- Inclusion of all patients with aortovascular conditions treated between March 1st and May 20th, 2020.
- Adaptation of intervention thresholds to ensure access for emergency and urgent cases.
Main Results:
- 189 patients were analyzed, with 182 undergoing surgery for conditions including aneurysms and acute aortic syndrome.
- Surgical timing: 40% emergency, 34% urgent, 26% elective.
- In-hospital mortality was 12%; peri-operative COVID-19 diagnosis did not increase mortality.
Conclusions:
- Aortovascular service provision in the UK was significantly altered during the pandemic.
- Emergency and urgent surgical activity was maintained, while elective procedures were minimal.
- Preoperative COVID-19 screening, isolation, and shielding protocols were effective in limiting viral incidence and maintaining comparable mortality rates.
Background:
A significant restructuring of the healthcare services has taken place since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, with elective surgery put on hold to concentrate intensive care resources to treat COVID-19 as well as to protect patients who are waiting for relatively low risk surgery from exposure to potentially infected hospital environment.
Methods:
Multicentre study, with 19 participating centers, to define the impact of the pandemic on the provision of aortovascular services and patients' outcomes after having adapted the thresholds for intervention to guarantee access to treatment for emergency and urgent conditions. Retrospective analysis of prospectively collected data, including all patients with aortovascular conditions admitted for surgical or conservative treatment from the 1st March to the 20th May 2020.
Results:
A total of 189 patients were analyzed, and 182 underwent surgery. Diagnosis included: aneurysm (45%), acute aortic syndrome (44%), pseudoaneurysm (4%), aortic valve endocarditis (4%), and other (3%). Timing for surgery was: emergency (40%), urgent (34%), or elective (26%). In-hospital mortality was 12%. Thirteen patients were diagnosed with COVID-19 during the peri-operative period, and this subgroup was not associated with a higher mortality.
Conclusions:
There was a significant change in service provision for aortovascular patients in the UK. Although the emergency and urgent surgical activity were maintained, elective treatment was minimal during early months of the pandemic. The preoperative COVID-19 screening protocol, combined with self-isolation and shielding, contributed to the low incidence of COVID-19 in our series and a mortality similar to that of pre-pandemic outcomes.
