Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal.
Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal.
Ann Vasc Surg. 2021 May;73:97-106. doi: 10.1016/j.avsg.2021.01.060. Epub 2021 Jan 22.
This study aims to report the changes and adaptations of a vascular tertiary center during a global pandemic and the impact on its activity and patients.
We conducted a retrospective cohort study within the Vascular Surgery ward in Centro Hospitalar Universitário Lisboa Norte, Portugal. All data from surgical, inpatient and outpatient activity were collected from February to June 2020 and compared to the same 5-month period in 2018 and 2019. We ran a descriptive analysis of all data and performed statistical tests for the variation of procedures and admissions between February and June 2018 and the same time period in 2020.
During the outbreak, our staff had to be readapted. Six nurses were transferred to COVID-19 units (out of a total of 33 nurses) while 1 of the 7 residents was transferred to an intensive care unit and 1 senior surgeon was put on prophylactic leave. In the outpatient clinic, there was an increase in the number of telemedicine consultations with a greater focus on first-time referrals and urgent cases. There was a significant increase in the total number of elective admissions whereas there were significantly less admissions from an emergency setting (+57% and -54%, respectively, P < 0.001). The vascular surgery team performed a total number of 584 procedures between February and June 2020 (-17.8% compared to 2018 and 2019), with a significant increase in the number of endovascular procedures (P < 0.001) and in the use of local and regional anesthesia (P < 0.001), especially in the Angio Suite (+600%, P < 0.001). Comparing with 2018 and 2019, the surgical team performed less outpatient procedures in early 2020. We reported a significant increase in the total number of procedures for patients with a chronic limb-threatening ischemia (CLTI) diagnosis (+21%, P < 0.001). We did not report significant changes in the proportion of other vascular conditions. Regarding mortality, we observed a 16% decrease in the intraoperative mortality (P 0.67).
In this study, we assessed the impact of the COVID-19 outbreak in daily activity during the contingency period. During the outbreak, there was an overall decline in outpatient clinics and inpatient admissions. Nevertheless, and despite the restrictions imposed by the pandemic and health authorities, we managed to maintain most procedures for most vascular diseases, particularly for CLTI urgent cases, without a significant increase in the mortality rate. Stringent protective measures for patient and staff or higher use of endovascular techniques and local anesthesia are some of the successful changes implemented in the department. These learned lessons are to be pursued as the pandemic evolves with future outbreaks of COVID-19, such as the current second outbreak currently spreading through Europe.
本研究旨在报告一家血管三级治疗中心在全球大流行期间的变化和调整情况，以及其对活动和患者的影响。
我们对葡萄牙里斯本北岸大学医院血管外科病房进行了一项回顾性队列研究。所有手术、住院和门诊活动的数据均于 2020 年 2 月至 6 月收集，并与 2018 年和 2019 年同期进行比较。我们对所有数据进行了描述性分析，并对 2018 年 2 月至 6 月和 2020 年同期手术和入院数量的变化进行了统计学检验。
在疫情期间，我们的工作人员必须重新适应。6 名护士被调往 COVID-19 病房（33 名护士中），而 7 名住院医师中有 1 名被调往重症监护病房，1 名高级外科医生被预防性休假。在门诊，远程医疗咨询的数量有所增加，重点是首次就诊和紧急情况。择期入院总数显著增加，而急诊入院数显著减少（分别增加 57%和减少 54%，P<0.001）。血管外科团队在 2020 年 2 月至 6 月期间共完成 584 例手术（与 2018 年和 2019 年相比减少 17.8%），其中腔内手术数量显著增加（P<0.001），局部和区域麻醉的使用也显著增加（P<0.001），尤其是在 Angio Suite（增加 600%，P<0.001）。与 2018 年和 2019 年相比，2020 年初外科团队的门诊手术数量减少。我们报告称，慢性肢体威胁性缺血（CLTI）患者的手术总数显著增加（增加 21%，P<0.001）。我们没有发现其他血管疾病比例的显著变化。关于死亡率，我们观察到术中死亡率下降了 16%（P<0.67）。
在这项研究中，我们评估了 COVID-19 疫情期间应急期间日常活动的影响。疫情期间，门诊和住院人数总体下降。然而，尽管受到大流行和卫生当局的限制，我们仍设法维持了大多数血管疾病的大多数手术，特别是 CLTI 紧急病例，死亡率没有显著增加。为患者和工作人员实施严格的保护措施，或更多地使用腔内技术和局部麻醉，是该科室实施的一些成功变革。随着 COVID-19 的发展和未来的疫情爆发，如当前正在欧洲蔓延的第二次疫情，这些经验教训将继续得到推广。
