Institute of Cancer and Genomics, University of Birmingham, Birmingham, United Kingdom and Newcastle upon Tyne, United Kingdom.
Ann Surg. 2021 Apr 1;273(4):630-635. doi: 10.1097/SLA.0000000000004722.
The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic.
During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions.
An international multi-center observational study of outcomes after open and endovascular interventions.
In an analysis of 1103 vascular intervention (57 centers in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 ± 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0% [aortic interventions mortality 15.2% (23/151), amputations 12.1% (28/232), carotid interventions 10.7% (11/103), lower limb revascularisations 9.8% (51/521)]. Chronic obstructive pulmonary disease [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.30-3.15] and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57-241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22-0.73 and 0.60, 95% CI 0.45-0.98, respectively. After adjustment, antiplatelet (OR 0.503, 95% CI: 0.273-0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205-0.824) were linked to reduced risk of in-hospital mortality.
Mortality after vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause, for example, recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.
COVE 研究的目的是确定大流行期间血管手术的全球结局和决策。
在最初的高峰期，有许多关于重要手术延迟的报告，并且发布了几项指南，建议对关键疾病的血管外科干预延迟阈值。
一项国际多中心观察性研究，对开放和血管内介入治疗后的结局进行分析。
在对 1103 例血管介入（19 个国家 57 个中心）的分析中，71.6%为择期或计划性手术。平均年龄为 67±14 岁（75.6%为男性）。有或无可疑或确诊 COVID-19 感染的记录分别为 4.0%和 0.4%。总体而言，院内死亡率为 11.0%[主动脉介入死亡率为 15.2%（23/151），截肢术为 12.1%（28/232），颈动脉介入术为 10.7%（11/103），下肢血运重建术为 9.8%（51/521）]。慢性阻塞性肺疾病[比值比（OR）2.02，95%置信区间（CI）1.30-3.15]和任何原因引起的活动性下呼吸道感染（OR 24.94，95%CI 12.57-241.70）与死亡率相关，而择期或计划性手术风险较低（OR 0.4，95%CI 0.22-0.73 和 0.60，95%CI 0.45-0.98）。调整后，抗血小板（OR 0.503，95%CI：0.273-0.928）和口服抗凝剂（OR 0.411，95%CI：0.205-0.824）与降低院内死亡率相关。
在此期间，血管介入治疗后的死亡率出乎意料地高。可疑或确诊 COVID-19 病例并不常见。因此，应考虑其他原因，例如建议延迟手术。血管界必须预测对生存的长期影响。
