Impact of COVID-19 on Patients Scheduled for Aortic Surgery

Abstract

COVID-19 has had an unprecedented effect on the global delivery of vascular surgical services. The international Vascular Surgery COVID-19 Collaborative (VASCC) registry prospectively recruited patients to evaluate the impact of surgical delay and subsequent natural history of patients awaiting scheduled aortic operations. The VASCC registry identified 127 patients with aortic disease whose operations were postponed during the 2020 COVID-19 pandemic. This interim analysis was conducted approximately 10 months after commencement of the registry based on data from centers in the United States. Data was collected on 127 planned aortic cases with a mean age of 70.7 years (standard deviation, 11.3 years), and 68.5% were male. The range of procedures delayed consisted of 100 for aneurysm repair (78.7%), 7 acute aortic syndromes (5.5%) (penetrating aortic ulcer, intramural hematoma, and subacute or chronic Type B dissection), and 18 endoleak procedures (14.2%) (Fig 1). As of this analysis, 89 (70%) of patients had completed surgeries with a median delay of 63 days (interquartile range, 42-98 days), with one patient undergoing unsuccessful emergency repair for aneurysm rupture. Eighteen patients (14.2%) were still waiting for surgery at the time of completion of the case report form, consisting of 17 aneurysms and one endoleak. Thirteen patients (10.2%) had their procedure permanently cancelled. Including the aforementioned rupture, another 5 patients (3.9%) were reported as having died after postponement of their aneurysm surgery (Fig 2). Mortality among aneurysm patients alone was 6% during the 10-month analysis period. At the time of analysis, 70% of postponed aortic procedures were completed with a median delay of 63 days. Nevertheless, six patients died as a result of postponed surgery, including one aneurysm rupture. Overall mortality of 6 patients (4.7%) over 10 months from COVID-19-related health service disruption underscores the wider impacts of this pandemic, and the importance of resource and contingency planning for future epidemics and natural disasters.Fig 2Outcome of delay.View Large Image Figure ViewerDownload Hi-res image Download (PPT)