26 Running a Safe Aortic Service in the Covid-Era

Abstract

Abstract Introduction Within the Covid-19 pandemic, elective surgery has been cancelled to increase critical care capacity. With two thirds of abdominal aortic aneurysm ruptures lethal, it is important to consider how to run a safe aortic service within the pandemic. Vascular patients have an increased risk of mortality from Covid-19. By considering ambulatory care, shortening hospital stay and discharging to level 1 care for non-complex infrarenal endovascular aneurism repairs (EVAR), critical care capacity can be kept available and exposure to nosocomial Covid-19 can be reduced. Method A retrospective audit of EVAR patient’s documentation examined the ASA, level of postoperative care, time to discharge, geographical and personal care factors. These were compared with pre-established criteria deeming suitability for ambulatory or ward level care. Results were presented locally and subsequent reaudit conducted. Results The initial audit included 40 records. 30% of patients were potential targets for ambulatory care with the median discharge on postoperative day 3. All patients were admitted to the high dependency unit (HDU) with 12.5% of patients receiving treatment that required a HDU level of care. Upon reaudit, 8 records were included with all patients admitted to HDU and the median day of discharge postoperative day 2. Notably, 37.5% patients were discharged on postoperative day 1 and a day of surgery admission (DOSA) process was implemented. Conclusions By reviewing a health board’s EVAR caseload, suitability for short stay EVARs can be assessed. Implementing an early discharge and DOSA process keeps care capacity available and may protect against nosocomial Covid-19.