Is it Possible to Safely Maintain a Regular Vascular Practice During the COVID-19 Pandemic?

Abstract

This paper evaluates the protocol adopted during the emergency phase of the COVID-19 pandemic to maintain elective activity in a vascular surgery unit while minimising the risk of contamination to both patients and physicians. All elective patients were submitted to nasopharyngeal swabs; all emergency patients were considered as possibly contaminated, in order to minimise contamination possibilities to other patients and hospital professionals. This approach should be considered in an emergency situation in high risk areas.Objective: This study aimed to evaluate the protocol adopted during the emergency phase of the COVID-19 pandemic to maintain elective activity in a vascular surgery unit while minimising the risk of contamination to both patients and physicians, and the impact of this activity on the intensive care (IC) resources. Methods: The activity of a vascular surgery unit was analysed from 8 March to 8 April 2020. Surgical activity was maintained only for acute or elective procedures obeying priority criteria. The preventive screening protocol consisted of nasopharyngeal swabs (NPS) for all patients and physicians with symptoms and for unprotected contact infected cases, and serological physician evaluations every 15 days. Patients treated in the acute setting were considered theoretically infected and the necessary protective devices were used. The number of patients and the possible infection of physicians were evaluated. The number and type of interventions and the need for post-operative IC during this period were compared with those in the same periods in 2018 and 2019. Results: One hundred and fifty-one interventions were performed, of which 34 (23%) were acute/emergency. The total number of interventions was similar to those performed in the same periods in 2019 and 2018: 150 (33, of which 22% acute/emergency) and 117 (29, 25% acute/emergency), respectively. IC was necessary after 6% (17% in 2019 and 20% in 2018) of elective operations and 33% (11) of acute/emergency interventions. None of the patients treated electively were diagnosed with COVID-19 infection during hospitalisation. Of the 34 patients treated in acute/emergency interventions, five (15%) were diagnosed with COVID-19 infection. It was necessary to screen 14 (47%) vascular surgeons with NPS after contact with infected colleagues, but none for unprotected contact with patients; all were found to be negative on NPS and serological evaluation. Conclusion: A dedicated protocol allowed maintenance of regular elective vascular surgery activity during the emergency phase of the COVID-19 pandemic, with no contamination of patients or physicians and minimal need for IC resources.

Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients

“…Recently, Pini et al reported the results of vascular surgical activity in the Bologna metropolitan area between 8 March and 8 April 2020. 19 Among 34 patients treated in the acute/ emergency setting, only two were operated on for ALI (one being positive to SARS-CoV-2), a number even lower than the same period in 2019. However, in that series, COVID-19 affected only 3.9% of patients (6/152), whereas in another experience COVID-19 was present in 21% of patients (64/ 305).…”

COVID-19 Impact on Vascular Surgery Practice: Experience From an Italian University Regional Hub Center for Vascular Pathology

“…The establishment of a strict emergency protocol allowed the continuation of vascular surgery activity during the COVID-19 pandemic outbreak, as underlined by the experience of some highvolume center for vascular pathology in northern Italy. [10][11][12] Despite this, 1 patient developed fever and respiratory symptoms during the postoperative hospital stay and tested positive for COVID-19 at the NPS. After the patient's transfer to the dedicated Unit, we continued to apply the same emergency protocol since no one among the other inpatients or our staff members were found positive at the NPS or developed symptoms suggestive for COVID-19 infection.…”

How Does SARS-CoV-2 Infection Affect Survival of Emergency Cardiovascular Patients? A Cohort Study From a German Insurance Claims Database

“…4,9e14 Only a few months later, the world faced a second pandemic wave, and numerous questions remained unanswered ahead of this challenge. 15,16 Because of the complex multimorbidity of patients with cardiovascular and cerebrovascular emergencies, these patients are known to be at particular risk of a SARS-CoV-2 infection and unfavourable outcomes. 17 The current study used large, updated health insurance claims data and additional information on confirmed SARS-CoV-2 infection status to further illuminate the impact of COVID-19 on in hospital mortality.…”