Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur J Vasc Endovasc Surg. 2021 Feb;61(2):306-315. doi: 10.1016/j.ejvs.2020.10.025. Epub 2020 Nov 13.
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.
在意大利 COVID-19 疫情最严重的时期，伦巴第大区确定了一些医院作为枢纽，这些枢纽医院被选中为整个地区提供高度专业化的服务，包括血管外科。本研究报告了伦巴第地区四个血管外科枢纽的经验，并根据 COVID-19 检测结果比较了住院死亡率和主要不良事件 (MAE)。
前瞻性收集 2020 年 3 月 9 日至 4 月 28 日期间转诊至血管外科部门的所有患者的数据进行分析。聚合酶链反应拭子检测 COVID-19 阳性，或伴有间质性肺炎的胸部计算机断层扫描的症状（体温>37.5°C、上呼吸道症状、胸痛和接触/旅行史）被认为是 COVID-19 疾病的诊断。根据 COVID-19 检测结果比较患者特征、手术变量和住院结局。使用多变量模型确定住院死亡和 MAE 的独立预测因素。
在 305 例纳入患者中，64 例（21%） COVID-19 检测阳性（COVID 组），241 例（79%） COVID-19 检测阴性（非 COVID 组）。与非 COVID 组相比，COVID 组患者更常出现急性肢体缺血（64% vs. 23%；p<0.001），住院死亡率明显更高（25% vs. 6%；p<0.001）。COVID 组的临床成功率、MAE、再干预、肺部和肾脏并发症明显更差。住院死亡的独立危险因素是 COVID（OR 4.1）、药物治疗（OR 7.2）和紧急情况（OR 13.6）。COVID（OR 3.4）、肥胖症 5 级（OR 13.5）和紧急情况（OR 4.0）是 MAE 发展的独立危险因素。
在伦巴第大区 COVID-19 大流行期间，急性肢体缺血是最常见的需要手术治疗的血管疾病。COVID-19 与死亡风险增加 4 倍和 MAE 风险增加 3 倍相关。
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