Correia Mafalda, Constâncio Vânia, Silva Joana Cruz, Lima Pedro, Moreira Mário, Antunes Luís F, Fonseca Manuel
Cirurgia Vascular, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Cirurgia Vascular, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Ann Vasc Surg. 2020 Nov;69:100-104. doi: 10.1016/j.avsg.2020.08.002. Epub 2020 Aug 11.
On March 2020, the World Health Organization declared the coronavirus disease 2019 outbreak a pandemic. During this period, surgical activity and admission to the Emergency Department (ED) decreased globally. The aim of this article is to understand how the admission of a patient to the ED for vascular surgery changed in our center in Portugal and if this situation prevented urgent surgical procedures.
Through a retrospective study, we compared the volume of patients admitted to the ED during the emergency state (ES) in Portugal with the same period in 2019. In addition, we analyzed the urgent surgical activity during the ES and in the correspondent period of the previous 10 years, regarding limb acute ischemia, acute aortic pathology, and vascular trauma. Two groups of patients were formed-patients operated during the ES and during the non-ES, for control. Statistical analysis was performed using IBM SPSS® Statistics, version 25.
In the ES, 115 patients were observed at the ED and 179 in the 2019 corresponding period. During the ES, patients significantly recurred less to the ED directly from home (P < 0.001) and were less referred to the ED by primary care doctors (P < 0.001). Patients observed at the ED were significantly more urgent-required urgent surgery or were admitted to the department-than those in 2019 (40% vs. 24%). However, there were no differences when only considering urgent surgery (14% in ES vs. 10% in 2019). In the ES, 38% of patients observed at the ED were discharged with no follow-up related to vascular surgery against 60% in 2019, although this difference was not significant. Compared with the preceding 10 years, there are not significant differences in the number of patients who underwent urgent surgery in both ES and non-ES periods. In patients with acute limb ischemia, we did not find an increase in the time between onset of symptoms and ED admission, during the ES.
Fewer patients were admitted at the ED during the ES, and those admitted were significantly more urgent. We did not find a decrease in the number of urgent surgeries when compared with the preceding 10 years. Therefore, we cannot assume that coronavirus pandemic precluded urgent surgical procedures.
2020年3月，世界卫生组织宣布2019冠状病毒病疫情为大流行。在此期间，全球范围内外科手术活动及急诊科（ED）的收治人数均有所下降。本文旨在了解葡萄牙我们中心因血管外科疾病收治入急诊科的患者情况有何变化，以及这种情况是否阻碍了紧急外科手术的开展。
通过一项回顾性研究，我们将葡萄牙紧急状态（ES）期间急诊科收治的患者数量与2019年同期进行了比较。此外，我们分析了紧急状态期间及此前10年相应时间段内，关于肢体急性缺血、急性主动脉病变和血管创伤的紧急外科手术活动情况。形成了两组患者——在紧急状态期间接受手术的患者和非紧急状态期间接受手术的患者作为对照。使用IBM SPSS® Statistics 25版进行统计分析。
在紧急状态期间，急诊科观察到115例患者，而2019年同期为179例。在紧急状态期间，直接从家中前往急诊科就诊的患者明显减少（P < 0.001），且初级保健医生转诊至急诊科的患者也减少（P < 0.001）。在急诊科观察到的患者比2019年的患者更急需紧急手术或入院治疗（40%对24%）。然而，仅考虑紧急手术时，两者并无差异（紧急状态期间为14%，2019年为10%）。在紧急状态期间，在急诊科观察到的患者中有38%出院时未进行与血管外科相关的随访，而2019年这一比例为60%，尽管这一差异并不显著。与此前10年相比，紧急状态期间和非紧急状态期间接受紧急手术的患者数量并无显著差异。对于急性肢体缺血患者，在紧急状态期间，我们未发现症状出现至入院时间有所增加。
紧急状态期间急诊科收治的患者减少，且收治的患者病情明显更紧急。与此前10年相比，我们未发现紧急手术数量减少。因此，我们不能认为新冠疫情阻碍了紧急外科手术的开展。
