Outcomes After Vascular Surgery Procedures in Patients with COVID-19 Infection: A National Multicenter Cohort Study (COVID-VAS)
E M San Norberto, J De Haro, R Peña, L Riera, D Fernández-Caballero, A Sesma, P Rodríguez-Cabeza, M Ballesteros, E Gómez-Jabalera, G T Taneva, C Aparicio, N Moradillo, I Soguero, A M Badrenas, R Lara, A Torres, V A Sala, C Vaquero, COVID-VAS Investigators from the Vascular Investigation Network (RIV) of the Spanish Society of Angiology and Vascular Surgery (SEACV), E M San Norberto, J De Haro, R Peña, L Riera, D Fernández-Caballero, A Sesma, P Rodríguez-Cabeza, M Ballesteros, E Gómez-Jabalera, G T Taneva, C Aparicio, N Moradillo, I Soguero, A M Badrenas, R Lara, A Torres, V A Sala, C Vaquero, COVID-VAS Investigators from the Vascular Investigation Network (RIV) of the Spanish Society of Angiology and Vascular Surgery (SEACV)
Abstract
Objectives: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic.
Methods: This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across Spain and Andorra between March and May 2020. The primary end point was 30-day mortality. Clinical Trials registry number NCT04333693.
Results: The mean age was 70.9 (45-94) and 58 (77.0%) patients were male. Around 70.7% had postoperative complications, 36.0% of patients experienced respiratory failure, 22.7% acute renal failure, and 22.7% acute respiratory distress syndrome (ARDS). All-cause 30-days mortality rate was 37.3%. Multivariate analysis identified age >65 years (P = 0.009), American Society of Anesthesiologists (ASA) classification IV (P = 0.004), preoperative lymphocyte count <0.6 (×109/L) (P = 0.001) and lactate dehydrogenase (LDH) >500 (UI/L) (P = 0.004), need for invasive ventilation (P = 0.043), postoperative acute renal failure (P = 0.001), ARDS (P = 0.003) and major amputation (P = 0.009) as independent variables associated with mortality. Preoperative coma (P = 0.001), quick Sepsis Related Organ Failure Assessment (qSOFA) score ≥2 (P = 0.043), lymphocytes <0.6 (×109/L) (P = 0.019) leucocytes >11.5 (×109/L) (P = 0.007) and serum ferritin >1800 mg/dL (P = 0.004), bilateral lung infiltrates on thorax computed tomography (P = 0.025), and postoperative acute renal failure (P = 0.009) increased the risk of postoperative ARDS. qSOFA score ≥2 was the only risk factor associated with postoperative sepsis (P = 0.041).
Conclusions: Patients with COVID-19 infection undergoing vascular surgery procedures showed poor 30-days survival. Age >65 years, preoperative lymphocytes <0.6 (x109/L) and LDH >500 (UI/L), and postoperative acute renal failure, ARDS and need for major amputation were identified as prognostic factors of 30-days mortality.
Copyright © 2021 Elsevier Inc. All rights reserved.
References
- Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:382–386.
- Update number 123 of coronavirus disease (COVID-10). 06/01/2020. Spanish Ministry of Health, Consumption and Social Welfare. Available at:
- CovidSurg. NIHR Global Health Research Unit on Global Surgery. Available at: .
- National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) Available at: (Accessed on April 03, 2020).
- Kellum JA, Lameire N, Group KAGW. Diagnosis, evaluation, and management of acute kidney injury: a Kdigo summary (Part1) Crit Care. 2013;17:204.
- Riviello ED, Kiviri W, Twagirumugabe T, et al. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali Modification of the Berlin Definition. Am J Respir Crit Care Med. 2016;193:52–59.
- Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382.
- Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810.
- Gouveia E Melo R, Mendes Pedros L. Vascualr surgery department adjustments in the era of the COVID-19 pandemic. J Vasc Surg. 2020;72:375–376.
- Tan LGW, Chandrasekar S, Lo ZJ, et al. Early experience in the COVID-19 pandemic from a vascular surgery unit in a Singapore tertiary hospital. J Vasc Surg. 2020;17:12–15.
- Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–147.
- Sena G, Gallelli G. An increased severity of peripheral arterial disease in the covid-19 era. J Vasc Surg. 2020;72:758.
- Etkin Y, Conway AM, Silpe J, et al. Acute arterial thromboembolism in patients with COVID-19 in the New York city area. Ann Vasc Surg. 2021;70:290–294.
- Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844–847.
- Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med. 2020;23:382. e38.
- Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-1o pneumonia. J Vasc Surg. 2020;29 S0741-5214(20)31080-6.
- Abdallah IB. Early experience in Paris with the impact of the COVID-19 pandemic on vascular surgery. J Vasc Surg. 2020;72:373.
- Wynants L, Van Calster B, Collins GS, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;7:369. m1328.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;28(395):1054–1062.
- Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81:e16–e25.
- Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;29 doi: 10.1111/joim.13091.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.
- Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25:278–280.
- Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet. 2020;395:514–523.
- Pei G, Zhang Z, Peng J, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020;31:1157–1165.
- Yang X, Jin Y, Li R, et al. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and meta-analysis. Crit Care. 2020;18:356.
- Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 105949.36.
- Luo P, Liu Y, Qiu L, et al. Tocilizumab treatment in COVID-19: a single center experience. J Med Virol. 2020;92:814–818.
- Montanari F, Tinelli G, Tshomba Y. Management of vascular surgical urgencies during COVID-19 pandemic. Ann Vasc Surg. 2021;70:295–296.
- Mascia D, Kahlberg A, Melloni A, et al. Single-center vascular hub experience after 7 weeks of COVID-19 pandemic in Lombardy (Italy) Ann Vasc Surg. 2020;69:90–99.
- Björck M, Boyle JR, Dick F. The need of research initiatives amidst and after Covid-19 pandemic: a message from the editors of the European Journal of Vascular and Endovascular Surgery. Eur J Vasc Endovasc Surg. 2020;59:695–696.
Source: PubMed