Unit of Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy.
Unit of Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Cardiovasc Surg (Torino). 2021 Feb;62(1):71-78. doi: 10.23736/S0021-9509.20.11564-7. Epub 2020 Sep 23.
To highlight differences in clinical practice among referral (hub, HH) or satellite (spoke, SH) hospital vascular surgery units (VSUs) in Lombardy, during the COVID-19 pandemic "phase 1" period (March 8 - May 3, 2020).
The Vascular Surgery Group of Regione Lombardia Register, a real-word, multicenter, retrospective register was interrogated. All patients admitted with vascular disease were included. Patients' data on demographics, COVID-19 positivity, comorbidities and outcomes were extrapolated. Two cohorts were obtained: patients admitted to HH or SH. Primary endpoint was 30-day mortality rate. Secondary outcomes were 30-day complications and amputation (in case of peripheral artery disease [PAD]) rates. Univariate and multivariate analysis were used to compare HH and SH groups and predictors of poor outcomes.
During the study period, 659 vascular patients in 4 HH and 27 SH were analyzed. Among these, 321 (48.7%) were admitted to a HH. No difference in COVID-19 positive patients was described (21.7% in HH vs. 15.9% in SH; P=0.058). After 30 days from intervention, HH and SH experienced similar mortality and no-intervention-related complication rate (12.1% vs. 10.0%; P=0.427 and 10.3% vs. 8.3%; P=0.377, respectively). Conversely, in HH postoperative complications were higher (23.4% vs. 16.9%, P=0.038) and amputations in patients treated for PAD were lower (10.8% vs. 26.8%; P<0.001) than in SH. Multivariate analysis demonstrated in both cohorts COVID-19-related pneumonia as independent predictor of death and postoperative complications, while age only for death.
HH and SH ensured stackable results in patients with vascular disease during COVID-19 "phase 1." Despite this, poor outcomes were observed in both HH and SH cohorts, due to COVID-19 infection and its related pneumonia.
在 COVID-19 大流行“第一阶段”（2020 年 3 月 8 日至 5 月 3 日）期间，突出伦巴第转诊（枢纽，HH）或卫星（辐条，SH）医院血管外科单位（VSUs）之间临床实践的差异。
伦巴第地区血管外科组注册处的真实、多中心、回顾性注册处进行了查询。所有因血管疾病入院的患者均被纳入。提取患者的人口统计学、COVID-19 阳性、合并症和结局数据。获得了两个队列：入住 HH 或 SH 的患者。主要终点是 30 天死亡率。次要结局是 30 天并发症和截肢（在周围动脉疾病 [PAD] 的情况下）率。使用单变量和多变量分析比较 HH 和 SH 组以及不良结局的预测因素。
在研究期间，对 4 个 HH 和 27 个 SH 中的 659 名血管患者进行了分析。其中，321 名（48.7%）入住 HH。HH 与 SH 之间 COVID-19 阳性患者的比例没有差异（HH 为 21.7%，SH 为 15.9%；P=0.058）。在干预后 30 天，HH 和 SH 的死亡率和无干预相关并发症发生率相似（12.1% vs. 10.0%；P=0.427 和 10.3% vs. 8.3%；P=0.377，分别）。相反，HH 术后并发症发生率较高（23.4% vs. 16.9%，P=0.038），PAD 治疗患者的截肢率较低（10.8% vs. 26.8%；P<0.001）。多变量分析表明，在两个队列中，COVID-19 相关肺炎是死亡和术后并发症的独立预测因素，而年龄仅与死亡相关。
在 COVID-19“第一阶段”期间，HH 和 SH 确保了血管疾病患者的可堆叠结果。尽管如此，HH 和 SH 两个队列都观察到了不良结局，这是由于 COVID-19 感染及其相关肺炎所致。
