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Caseload and In-Hospital Outcome of Carotid Surgery Performed during the COVID-19 Pandemic vs. Previous Years: A
Werner Westreicher1, Alina Goidinger1, Ingrid Gruber1
1Vascular Surgery, Medizinische Universität Innsbruck, Innsbruck, Austria.
Insights
The COVID-19 pandemic significantly reduced carotid artery surgeries, but outcomes remained safe and feasible. This study found no worsening of major adverse events during the pandemic despite lower caseloads.
Area of Science:
- Vascular Surgery
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic introduced significant challenges to healthcare systems globally.
- Vascular surgery, including carotid artery procedures, faced disruptions and concerns regarding patient outcomes.
Purpose of the Study:
- To compare the volume and outcomes of carotid artery surgeries performed at a single center before and during the COVID-19 pandemic.
- To assess the safety and feasibility of carotid artery interventions amidst pandemic-related restrictions.
Main Methods:
- Retrospective analysis of consecutive patients undergoing carotid surgery between January 2017 and December 2021.
- Comparison of surgical caseload, patient demographics, operative parameters, and in-hospital outcomes between pre-pandemic (2017-2019) and pandemic (2020-2021) periods.
- Statistical analysis of major adverse event rates, including postoperative bleeding, stroke, myocardial infarction, and death.
Main Results:
- A significant reduction in carotid artery surgery caseload was observed during the pandemic years (2020: -36.6%, 2021: -17.9%) with no subsequent rebound.
- The proportion of symptomatic versus asymptomatic patients undergoing surgery remained comparable between the periods.
- Major adverse event rates, including stroke and death, did not significantly worsen during the pandemic, indicating maintained surgical safety.
Conclusions:
- Carotid artery surgery volumes decreased substantially during the COVID-19 pandemic.
- Despite reduced caseloads, carotid artery surgery remained a safe and feasible procedure with no increase in adverse outcomes.
- The findings highlight the resilience of specialized surgical services in adapting to public health crises.
Abstract:
With the beginning of the COVID-19 pandemic in March 2020, restrictions and challenges for elective and emergency vascular surgery as well as worse outcomes were reported. This study aims to compare our single-centre experience with carotid artery surgery during the pandemic and previous years.Our retrospective analysis included all consecutive patients undergoing carotid surgery for symptomatic and asymptomatic stenosis between January 2017 and December 2021. Caseload, operation specific parameters, and demographic data as well as in-hospital outcome were compared during the COVID-19 pandemic versus previous years.A total of 623 consecutive patients were included. The caseload comparison showed an average of 112 carotid artery surgeries per adjusted year (March 16th to December 31st) from 2017 to 2019, prior to the pandemic. The caseload reduction in the first year of the pandemic (2020) was 36.6% (n = 71) and 17.9% (n = 92) in the second year (2021). No rebound effect was observed. There was no significant difference (p = 0.42) in the allocation of symptomatic and asymptomatic patients (asymptomatic patients: 37.1% prior vs. 40.8% during the pandemic; symptomatic patients: 62.9 vs. 59.2%). Major adverse event rates in years prior to the pandemic were postoperative bleeding requiring revision: n = 31 (7.1%); stroke in symptomatic patients: n = 9 (3.3%) and stroke in asymptomatic patients: n = 4 (2.5%); symptomatic myocardial infarction (MCI): n = 1 (0.2%); death: n = 2 (0.5%). During the pandemic, major adverse event rates were postoperative bleeding requiring revision: n = 12 (6.5%); stroke in symptomatic patients: n = 1 (0.9%), stroke in asymptomatic patients: n = 1 (1.3%); symptomatic MCI: n = 1 (0.5%); death: n = 1 (0.5%).Since the beginning of the COVID-19 pandemic in March 2020, there has been a significant reduction in carotid artery surgery performed both in symptomatic as well as in asymptomatic patients. There was no worsening of the outcome of carotid surgery performed during the COVID-19 pandemic, and this remained safe and feasible.
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