The impact of the COVID-19 pandemic on vascular surgery practice in the United States

Abstract

Introduction The coronavirus disease 2019 (COVID-19) pandemic has led to widespread postponement and cancelation of elective surgeries in the United States. We designed and administered a global survey to examine the impact of COVID-19 on vascular surgeons. We describe the impact of the pandemic on the practices of Vascular Surgeons in the United States. Methods The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons is an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Task Force disseminated April 14-24, 2020. This analysis focuses on pattern changes in vascular surgery practices in the United States including the inpatient setting, ambulatory, and vascular laboratory setting. Specific questions regarding occupational exposure to COVID-19, adequacy of personal protective equipment (PPE), elective surgical practice, changes in call schedule, and redeployment to non-vascular surgery duties were also included in the survey. Regional variation was assessed. The survey data were collected using REDCap and analyzed using descriptive statistics. Results A total of 535 vascular surgeons responded to the survey from 45 states. Most of the respondents were male (73.1%), White (70.7%), practiced in urban settings (81.7%), and in teaching hospitals (66.8%). Almost half were in hospitals with greater than 400 beds (46.4%). There was no regional variation in the presence of pre-operative COVID-19 testing, COVID-19 OR protocols, adherence to national surgical standards, and the presence of PPE. The overwhelming majority of respondents (91.7%) noted elective surgery cancellation, with the Northeast and Southeast regions having the most case cancellations 94.2% and 95.8% respectively %). The Northeast region reported the highest percentage of operations/procedures on patients with COVID-19, which was either identified at the time of the surgery or later in the hospital course (82.7%). Ambulatory visits were performed via telehealth (81.3%), with 71.1% having restricted hours. Over half of OBLs were closed, although there was regional variation with over 80% in the Midwest being closed. Cases performed in OBLs focused on critical limb ischemia (42.9%) and dialysis access maintenance (39.9%). Call schedules modifications were common, although the number of call days remained the same (45.8%). Conclusions Vascular surgeons in the United States report substantial impact on their practices during the COVID-19 pandemic, and regional variations are demonstrated - particularly in OBL utilization, ICU bed availability, and COVID-19 exposure at work.

Progression of Changes in Vascular Surgery Practices during the Novel Corona Virus SARS-CoV-2 Pandemic

“…It was no surprise, then that in our initial survey in the early pandemic, 79% of the vascular surgeons across the country stated that they had easy access to PPE while only 63% had easy access to N95 masks. These numbers were similar to other surveys performed during the pandemic that showed about 80% of surgeons reported having adequate access to PPE at that time 3 . With changes in resource utilization, increasing supplies, and practice pattern changes, access to PPE has improved by the late pandemic time point to 94% having easy access to PPE and 83% having access to N95 masks, despite there being more patients being treated in many hospital settings for COVID-19 as compared to earlier in the pandemic.…”

“…JID: AVSG [mNS; 21:10 ] at that time 3 . With changes in resource utilization, increasing supplies, and practice pattern changes, access to PPE has improved by the late pandemic time point to 94% having easy access to PPE and 83% having access to N95 masks, despite there being more patients being treated in many hospital settings for COVID-19 as compared to earlier in the pandemic.…”

“…The effects of the COVID-19 pandemic upon clinical care, workforce environments and clinically generated revenue and compensation have been ubiquitous and with deep consequence for nearly all vascular surgeons within the United States 1 , 2 , 3 as well as those around the world 4 , 5 , 6 . Threat responses from COVID-19 upon healthcare resources and health systems have been varied as different regions of the United States have experienced surging in differing numbers of cases, and therefore different strains upon resources.…”

Elective Surgical Delays Due to COVID-19

“…Cardiovascular procedural care, although frequently considered urgent or emergent, has likewise experienced a significant decrease in volume. 1 , 2 Recent reports from Asia, the United States, and Europe have highlighted not only the lost volume of procedures, but also delays in care for time-sensitive cardiovascular conditions, such as acute myocardial infarction. 3 – 6 Similar effects have been observed anecdotally within our health system and state.…”

The initial experience and response of vascular surgeons in Michigan during the COVID-19 pandemic

“…The effect of COVID-19 on the practice of vascular surgery in the United States was studied as well as vascular surgeons' experience, stressors, and coping mechanisms during the pandemic, and described elsewhere. 12,13 For the foreseeable future, operational efficiency will be paramount to navigate the backlog of non-COVID-19 vascular surgery cases affected by the pandemic. Prioritization of vascular operations will be a very important part of the ramping up and it is expected that hospitals and health systems will look to the cardiovascular service line to help improve the much needed future margins.…”