Editor's Choice - Outcomes of Surgery for Patients with Peripheral Arterial Disease During the COVID-19 Pandemic in the United Kingdom: A Population Based Study

Panagiota Birmpili; Qiuju Li; Amundeep S Johal; Sam Waton; Eleanor Atkins; Jonathan R Boyle; Ian Chetter; Robin Williams; Arun D Pherwani; David A Cromwell

doi:10.1016/j.ejvs.2023.02.002

Editor's Choice - Outcomes of Surgery for Patients with Peripheral Arterial Disease During the COVID-19 Pandemic in the United Kingdom: A Population Based Study

Eur J Vasc Endovasc Surg. 2023 May;65(5):738-746. doi: 10.1016/j.ejvs.2023.02.002. Epub 2023 Feb 10.

Authors

Affiliations

¹ Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, Hull, UK. Electronic address: Panagiota.Birmpili@nhs.net.
² Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
³ Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
⁴ Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, Hull, UK.
⁵ Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
⁶ Hull York Medical School, Hull, UK; Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK.
⁷ Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, UK.
⁸ Staffordshire & South Cheshire Vascular Network, Royal Stoke University Hospital, Stoke-on-Trent, UK.

Abstract

Objective: There is limited information on changes in the patterns of care and outcomes for patients who had vascular procedures after the first wave of the COVID-19 pandemic. The aim of this population based study was to examine the patterns of care and outcomes for vascular lower limb procedures in the UK during the COVID-19 pandemic.

Methods: Lower limb revascularisations and major amputations performed from January 2019 to April 2021 in the UK and entered in the National Vascular Registry were included in the study. The primary outcome was in hospital post-operative death and secondary outcomes were complications and re-interventions. The study was divided into Pre-pandemic (1 January 2019 - 29 February 2020), Wave 1 (1 March - 30 June 2020), Respite (1 July - 31 October 2020), Wave 2/3 (1 November 2020 - 30 April 2021).

Results: The study included 36 938 procedures (7 245 major amputations, 16 712 endovascular, 12 981 open revascularisations), with 15 501 procedures after March 2020, a 27.7% reduction compared with pre-pandemic. The proportion of open surgical procedures performed under general anaesthetic was lower in Wave 1 and after compared with pre-pandemic (76.7% vs. 81.9%, p < .001). Only 4.6% of patients in the cohort had SARS-CoV-2 infection (n = 708), but their in hospital post-operative mortality rate was 25.0% (n = 177), six times higher than patients without SARS-CoV-2 (adjusted odds ratio 5.88; 95% CI 4.80 - 7.21, p < .001). The in hospital mortality rate was higher during the pandemic than pre-pandemic after elective open and endovascular revascularisation (respectively 1.6% vs. 1.1%, p = .033, and 0.9% vs. 0.5%, p = .005) and after major amputations (10.4% during Wave 2/3 vs. 7.7% pre-pandemic, p = .022).

Conclusion: There was excess post-operative mortality rate for patients undergoing lower limb vascular procedures during the pandemic, which was associated with SARS-CoV-2 infections. Further research should be conducted on long term outcomes of patients operated on during the COVID-19 pandemic period.

Keywords: Amputation; COVID-19; Peripheral arterial disease; Revascularisation; United Kingdom Vascular surgery.