Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT.
Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Ann Vasc Surg. 2024 Nov;108:26-35. doi: 10.1016/j.avsg.2024.03.025. Epub 2024 May 28.
The COVID-19 pandemic necessitated postponement of vascular surgery procedures nationally. Whether procedure volumes have since recovered remains undefined. Therefore, our objective was to quantify changes in procedure volumes and determine whether surgical volume has returned to its prepandemic baseline.
This study was a retrospective cross-sectional study between 2018 and 2023 using the US Fee-for-Service Medicare 5% National Sample as part of the VA Disrupted Care National Project. We studied patients who underwent 1 of 3 procedures: abdominal aortic aneurysm (AAA) repair for intact aneurysms, carotid endarterectomy (CEA), and major lower extremity amputation (LEA). The case volume of each quarter of 2020-2023 was compared to its corresponding prepandemic quarter in 2019. We then performed a subanalysis of these trends by sex, age, and race.
We identified 21,031 procedures: 4,411 AAA repair, 8,361 CEA, and 8,259 LEA. The average percent change during the baseline prepandemic period from 2018 to 2019 was -4.3% for AAA repair, -8.5% for CEA, and -2.6% for LEA. Compared to Q2 of 2019, Q2 of 2020 demonstrated that AAA repair procedures decreased by 47%, CEA by 40%, and LEA by 14%. While procedures initially rebounded in Q3 of 2020, volumes did not return to their prepandemic baseline, demonstrating a persistent volume reduction (-16% AAA, -22% CEA, and -11% LEA). Thereafter, procedure counts again declined in Q1 of 2022 (-25% AAA, -34% CEA, and -25% LEA).
Despite a perception that vascular surgical care was singularly disrupted at the outset of the pandemic, there has been a sustained reduction in vascular surgical volume since 2019. Not only have procedure volumes not returned to prepandemic baseline but it also appears that there has been a cumulative incremental impact on overall procedure volume. The impact of these findings on long-term population health remains uncertain and necessitates a better understanding of postpandemic care delivery.
COVID-19 大流行迫使全国范围内推迟了血管外科手术。此后手术量是否恢复仍未确定。因此，我们的目标是量化手术量的变化，并确定手术量是否已恢复到大流行前的基线。
这是一项回顾性的 2018 年至 2023 年期间的横断面研究，使用了美国付费服务 Medicare 5%全国样本，作为 VA 中断护理国家项目的一部分。我们研究了接受以下 3 种手术之一的患者：腹主动脉瘤（AAA）修复术（用于未破裂的动脉瘤）、颈动脉内膜切除术（CEA）和下肢主要截肢术（LEA）。2020 年至 2023 年每个季度的病例量与 2019 年同期的大流行前季度进行了比较。然后，我们按性别、年龄和种族对这些趋势进行了亚分析。
我们确定了 21,031 例手术：4,411 例 AAA 修复术、8,361 例 CEA 和 8,259 例 LEA。2018 年至 2019 年大流行前基线期间的平均百分比变化为 AAA 修复术减少 4.3%，CEA 减少 8.5%，LEA 减少 2.6%。与 2019 年第 2 季度相比，2020 年第 2 季度 AAA 修复术减少了 47%，CEA 减少了 40%，LEA 减少了 14%。虽然手术量在 2020 年第 3 季度最初有所反弹，但并未恢复到大流行前的基线水平，表明手术量持续减少（AAA 减少 16%，CEA 减少 22%，LEA 减少 11%）。此后，2022 年第 1 季度手术量再次下降（AAA 减少 25%，CEA 减少 34%，LEA 减少 25%）。
尽管人们普遍认为血管外科护理在大流行开始时受到了严重干扰，但自 2019 年以来，血管外科手术量持续减少。手术量不仅没有恢复到大流行前的基线水平，而且似乎对整体手术量产生了累积的增量影响。这些发现对长期人群健康的影响仍不确定，需要更好地了解大流行后的护理提供情况。
