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North American lower-extremity revascularization and amputation during COVID-19: Observations from the Vascular Quality Initiative.
Lou, Jun-Yang; Kennedy, Kevin F; Menard, Matthew T; Abbott, J Dawn; Secemsky, Eric A; Goodney, Philip P; Saad, Marwan; Soukas, Peter A; Hyder, Omar N; Aronow, Herbert D.
  • Lou JY; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Kennedy KF; Independent statistical Consultant, Kansas City, MO, USA.
  • Menard MT; Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Abbott JD; Division of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA.
  • Secemsky EA; Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
  • Goodney PP; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
  • Saad M; Division of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA.
  • Soukas PA; Division of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA.
  • Hyder ON; Division of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA.
  • Aronow HD; Division of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA.
Vasc Med ; 26(6): 613-623, 2021 12.
Article in English | MEDLINE | ID: covidwho-1282193
ABSTRACT

INTRODUCTION:

The coronavirus disease 2019 (COVID-19) pandemic's impact on vascular procedural volumes and outcomes has not been fully characterized.

METHODS:

Volume and outcome data before (1/2019 - 2/2020), during (3/2020 - 4/2020), and following (5/2020 - 6/2020) the initial pandemic surge were obtained from the Vascular Quality Initiative (VQI). Volume changes were determined using interrupted Poisson time series regression. Adjusted mortality was estimated using multivariable logistic regression.

RESULTS:

The final cohort comprised 57,181 patients from 147 US and Canadian sites. Overall procedure volumes fell 35.2% (95% CI 31.9%, 38.4%, p < 0.001) during and 19.8% (95% CI 16.8%, 22.9%, p < 0.001) following the surge, compared with presurge months. Procedure volumes fell 71.1% for claudication (95% CI 55.6%, 86.4%, p < 0.001) and 15.9% for chronic limb-threatening ischemia (CLTI) (95% CI 11.9%, 19.8%, p < 0.001) but remained unchanged for acute limb ischemia (ALI) when comparing surge to presurge months. Adjusted mortality was significantly higher among those with claudication (0.5% vs 0.1%; OR 4.38 [95% CI 1.42, 13.5], p = 0.01) and ALI (6.4% vs 4.4%; OR 2.63 [95% CI 1.39, 4.98], p = 0.003) when comparing postsurge with presurge periods.

CONCLUSION:

The first North American COVID-19 pandemic surge was associated with a significant and sustained decline in both elective and nonelective lower-extremity vascular procedural volumes. When compared with presurge patients, in-hospital mortality increased for those with claudication and ALI following the surge.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Peripheral Arterial Disease / Endovascular Procedures / COVID-19 / Amputation, Surgical Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: Vasc Med Journal subject: Vascular Diseases Year: 2021 Document Type: Article Affiliation country: 1358863X211021918

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Peripheral Arterial Disease / Endovascular Procedures / COVID-19 / Amputation, Surgical Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: Vasc Med Journal subject: Vascular Diseases Year: 2021 Document Type: Article Affiliation country: 1358863X211021918