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North American lower-extremity revascularization and amputation during COVID-19: Observations from the Vascular
Jun-Yang Lou1, Kevin F Kennedy2, Matthew T Menard3
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
The COVID-19 pandemic caused a significant drop in vascular procedures. Post-surge, patients with claudication and acute limb ischemia (ALI) experienced higher mortality rates.
Area of Science:
- Vascular Surgery
- Public Health
- Epidemiology
Background:
- The impact of the COVID-19 pandemic on vascular procedural volumes and patient outcomes remains incompletely understood.
- Characterizing these effects is crucial for understanding healthcare system strain and patient management during public health crises.
Purpose of the Study:
- To analyze the changes in lower-extremity vascular procedural volumes and associated mortality during and after the initial COVID-19 pandemic surge.
- To compare outcomes for patients undergoing vascular procedures before, during, and after the initial pandemic wave.
Main Methods:
- Utilized data from the Vascular Quality Initiative (VQI) for 57,181 patients across 147 sites in the US and Canada.
- Employed interrupted Poisson time series regression to assess volume changes and multivariable logistic regression for adjusted mortality.
- Compared procedural data from January-February 2020 (presurge), March-April 2020 (surge), and May-June 2020 (post-surge).
Main Results:
- Overall vascular procedure volumes decreased by 35.2% during the surge and 19.8% post-surge compared to presurge levels.
- Significant volume reductions were observed for claudication (71.1% decrease) and chronic limb-threatening ischemia (CLTI) (15.9% decrease).
- Adjusted in-hospital mortality increased post-surge for claudication (OR 4.38) and acute limb ischemia (ALI) (OR 2.63) compared to the presurge period.
Conclusions:
- The initial North American COVID-19 surge led to a substantial and lasting decrease in lower-extremity vascular procedures.
- In-hospital mortality rose for patients with claudication and ALI following the pandemic surge compared to presurge cohorts.
Introduction:
The coronavirus disease 2019 (COVID-19) pandemic's impact on vascular procedural volumes and outcomes has not been fully characterized.
Methods:
Volume and outcome data before (1/2019 - 2/2020), during (3/2020 - 4/2020), and following (5/2020 - 6/2020) the initial pandemic surge were obtained from the Vascular Quality Initiative (VQI). Volume changes were determined using interrupted Poisson time series regression. Adjusted mortality was estimated using multivariable logistic regression.
Results:
The final cohort comprised 57,181 patients from 147 US and Canadian sites. Overall procedure volumes fell 35.2% (95% CI 31.9%, 38.4%, p < 0.001) during and 19.8% (95% CI 16.8%, 22.9%, p < 0.001) following the surge, compared with presurge months. Procedure volumes fell 71.1% for claudication (95% CI 55.6%, 86.4%, p < 0.001) and 15.9% for chronic limb-threatening ischemia (CLTI) (95% CI 11.9%, 19.8%, p < 0.001) but remained unchanged for acute limb ischemia (ALI) when comparing surge to presurge months. Adjusted mortality was significantly higher among those with claudication (0.5% vs 0.1%; OR 4.38 [95% CI 1.42, 13.5], p = 0.01) and ALI (6.4% vs 4.4%; OR 2.63 [95% CI 1.39, 4.98], p = 0.003) when comparing postsurge with presurge periods.
Conclusion:
The first North American COVID-19 pandemic surge was associated with a significant and sustained decline in both elective and nonelective lower-extremity vascular procedural volumes. When compared with presurge patients, in-hospital mortality increased for those with claudication and ALI following the surge.
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