Unit of Vascular Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy -
Humanitas University, Pieve Emanuele, Milan, Italy -
Int Angiol. 2022 Oct;41(5):444-453. doi: 10.23736/S0392-9590.22.04884-2. Epub 2022 Aug 1.
To face the "first wave" of the pandemic (01/03/2020-15/05/2020), Lombardy's healthcare system was reorganized according to the "Hub-and-Spoke" model, and deferrable inpatient and outpatient activities were suspended. The limitations imposed by COVID-19, associated with patients' fear of presenting to medical attention, may have led to a delay in diagnosis and treatment of time-dependent pathologies. Our multicenter retrospective cohort study aims at analyzing the impact on COVID-negative patients of the shift of medical resources in Lombardy, the Italian epicenter of the pandemic.
Inclusion criteria were an age ≥18, COVID-negative condition, and referral to IRCCS Istituto Clinico Humanitas - Rozzano, Milan (Spoke Center) or IRCCS Ospedale San Raffaele - Milan (Hub Center) for acute vascular diseases requiring urgent treatment. SARS-CoV-2 infection, either on admission or during hospitalization, was the exclusion criterion. Data of the "first wave" were compared with the corresponding months of 2019, to highlight differences in vascular pathologies' case rates, clinical presentation, treatment type and post-treatment outcomes (mortality, rate of adverse events, primary and secondary clinical success and of amputation).
Two hundred and two patients were treated for acute vascular diseases, 52 in 2019, 150 in 2020 (P<0.001). A later presentation to medical attention (4.3 versus 5.9 days after symptoms onset, P=0.03) and an increased need for urgent treatment for peripheral arterial disease (P=0.04) differentiated 2020. A higher number of peripheral arterial disease patients underwent major amputations (P=0.38). Access to post-surgical rehabilitation programs was restricted (P<0.001).
During the first wave of COVID-19 pandemic, in the face of a radical health care rearrangement, no increase in mortality nor in post-operative adverse event rate was registered. Anyway, urgent hospitalizations for vascular disease increased, more specifically for peripheral ischemia, in which late presentation may have influenced an increase in amputation rate.
为应对疫情“第一波”（2020 年 3 月 1 日至 5 月 15 日），伦巴第大区的医疗系统根据“枢纽-辐条”模式进行了重组，暂停了可推迟的住院和门诊活动。COVID-19 带来的限制，以及患者对就诊的恐惧，可能导致一些与时间相关的疾病的诊断和治疗延迟。我们的多中心回顾性队列研究旨在分析伦巴第大区（意大利疫情的中心）医疗资源转移对 COVID-19 阴性患者的影响。
纳入标准为年龄≥18 岁，COVID-19 阴性，因急性血管疾病需紧急治疗而转诊至米兰的 IRCCS Istituto Clinico Humanitas - Rozzano（辐条中心）或米兰的 IRCCS Ospedale San Raffaele - Milan（枢纽中心）。SARS-CoV-2 感染，无论是入院时还是住院期间，均为排除标准。将“第一波”的数据与 2019 年同期进行比较，以突出血管疾病发病率、临床表现、治疗类型和治疗后结局（死亡率、不良事件发生率、主要和次要临床成功率以及截肢率）的差异。
2020 年有 202 名患者因急性血管疾病接受治疗，2019 年为 52 名（P<0.001）。就诊时间较晚（症状出现后 4.3 天 vs. 5.9 天，P=0.03）和外周动脉疾病紧急治疗需求增加（P=0.04）是 2020 年的区别。更多的外周动脉疾病患者接受了大截肢（P=0.38）。术后康复计划的机会受到限制（P<0.001）。
在 COVID-19 大流行的第一波期间，在彻底的医疗保健重组中，没有记录到死亡率或术后不良事件发生率的增加。然而，血管疾病的紧急住院治疗增加，特别是外周缺血，就诊较晚可能会导致截肢率增加。
