As of May 3, 2020, more than four million people worldwide have been diagnosed with coronavirus disease 2019 (COVID-19). The number of vascular surgeries has been significantly reduced according to the guidance provided by the American College of Surgeons, including surgeries related to peripheral arterial disease (PAD).
Since January 23, 2020, Beijing initiated the first-level response mechanism for public health emergencies; our center stopped elective surgeries and most semielective surgeries. To study the impact of COVID-19 on PAD, we collected the clinical data and perioperative results of patients with PAD undergoing surgery in our center from January 24, 2020 to March 31, 2020 (group A) and compared with the same period last year (group B).
Baseline patient characteristics and perioperative results
|Variablesa||Group A||Group B||P|
|The number of patiences with PAD undergoing surgery||15||50||-|
|Age, years||70.93 ± 10.18||69.22 ± 9.67||0.554|
|Male||12 (80)||38 (76)||1.000|
|Rutherford 4–6||13 (86.7)||29 (58)||0.042|
|Perioperative complicationsb||4 (26.7)||2 (4)||0.022|
|Perioperative death||1 (6.7)||1 (2)||0.551|
aCategorical variables are presented as number (%) and continuous variables as mean ± standard deviation. Categorical variables across groups were compared using Pearson’s χ2 test or Fisher’s exact test. Across-group comparison of means was completed using an analysis of variance. Results with P values < 0.05 were considered statistically significant.
bComplications during this pandemic included 2 cases of acute coronary syndrome (ACS), 1 case of acute respiratory distress syndrome (ARDS), and 1 case of severe pulmonary infection. The 2 complications in last year included 1 ACS and 1 complication of puncture site.
During this pandemic, the surgical indications of patients with PAD became more stringent, and the patients’ willingness to seek medical treatment also changed. The number of patients with PAD undergoing surgery in our center was significantly reduced, but their degree of limb ischemia was significantly more serious than last year, leading to an increased rate of perioperative complication. Although there is no different in perioperative mortality between these two groups, further follow-up is still needed for long-term results.
Unfortunately, there was one patient who died before surgery this year; this patient admitted to our center during this pandemic complicated with toxic shock; bedside hemofiltration and debridement were performed, but the patient still died of respiratory failure. With the conditions of patients with PAD getting more serious when they come to the hospital, it is necessary to choose appropriate treatment to control perioperative complications and mortality. Before this, it is more important for patients to maintain the medical treatment for PAD. Also, continuity of follow-up is key; it is necessary to evaluate the patient’s condition through telephone and phone application (obtain pictures of the patient’s ischemia limb) and urge them to go to hospital in time when the condition worsens. Finally, on the basis of controlling the COVID-19 pandemic, daily medical activities should be resumed as soon as possible to provide reasonable treatment for more patients with PAD.
Content Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265821/
Author Information: Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Hai Feng: moc.361@svyyhf