Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients.
Aged
COVID-19
/ diagnosis
COVID-19 Testing
/ methods
Emergencies
/ epidemiology
Emergency Service, Hospital
/ organization & administration
Female
Hospital Mortality
Humans
Infection Control
/ methods
Italy
/ epidemiology
Male
Outcome and Process Assessment, Health Care
Postoperative Complications
/ epidemiology
Prognosis
Retrospective Studies
Risk Adjustment
/ methods
Risk Factors
SARS-CoV-2
/ isolation & purification
Vascular Diseases
/ diagnosis
Vascular Surgical Procedures
/ adverse effects
Covid-19
Limb ischaemia
Lombardy
Pandemics
SARS-CoV-2
Vascular surgery
Journal
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
ISSN: 1532-2165
Titre abrégé: Eur J Vasc Endovasc Surg
Pays: England
ID NLM: 9512728
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
03
06
2020
revised:
21
10
2020
accepted:
28
10
2020
pubmed:
3
12
2020
medline:
23
2
2021
entrez:
2
12
2020
Statut:
ppublish
Résumé
During the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing. Data from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs. Among 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs. During the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events.
Identifiants
pubmed: 33262093
pii: S1078-5884(20)30935-7
doi: 10.1016/j.ejvs.2020.10.025
pmc: PMC7664352
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
306-315Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
Références
Eur J Vasc Endovasc Surg. 2017 Jun;53(6):811-819
pubmed: 28392057
J Vasc Surg. 2020 Jul;72(1):4-5
pubmed: 32360680
N Engl J Med. 2020 Feb 20;382(8):727-733
pubmed: 31978945
J Vasc Surg. 2014 Jan;59(1):220-34.e1-2
pubmed: 24126108
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
Circulation. 2020 Jul 7;142(1):68-78
pubmed: 32293910
Eur J Vasc Endovasc Surg. 2020 Mar;59(3):339-384
pubmed: 32035742
Eur J Vasc Endovasc Surg. 2020 Jul;60(1):127-134
pubmed: 32499169
J Vasc Surg. 2020 Dec;72(6):1864-1872
pubmed: 32360679
Crit Care Resusc. 2020 Apr 01;22(2):91-94
pubmed: 32227819
Crit Care Resusc. 2020 Apr 15;22(2):95-97
pubmed: 32294809
Eur J Vasc Endovasc Surg. 2020 Jul;60(1):156-157
pubmed: 32410815
Eur J Vasc Endovasc Surg. 2020 Aug;60(2):167-168
pubmed: 32605851
Glob Heart. 2014 Mar;9(1):159-70
pubmed: 25432125
J Vasc Surg. 2002 May;35(5):1048-60
pubmed: 12021727
Intern Emerg Med. 2009 Oct;4(5):413-8
pubmed: 19707845
J Vasc Surg. 2002 May;35(5):1061-6
pubmed: 12021728
Emerg Microbes Infect. 2020 Dec;9(1):687-690
pubmed: 32208840
Eur J Vasc Endovasc Surg. 2019 Jan;57(1):8-93
pubmed: 30528142
J Vasc Surg. 1997 Sep;26(3):517-38
pubmed: 9308598
Eur J Vasc Endovasc Surg. 2020 Feb;59(2):173-218
pubmed: 31899099
Eur J Vasc Endovasc Surg. 2018 Aug;56(2):217-237
pubmed: 29776646
J Am Coll Surg. 2020 Jun;230(6):1080-1091.e3
pubmed: 32240770