The Sustained Impact of the COVID-19 Pandemic on Vascular Surgical Care Delivery

Abstract

The coronavirus disease 2019 (COVID-19) pandemic necessitated postponement of vascular surgery procedures nationally. Whether procedure volumes have since recovered remains undefined. Therefore, we sought to quantify changes in procedure volumes and determine whether surgical volume has returned to its prepandemic baseline. We utilized the US Fee-for-Service Medicare 5% National Sample as part of the Department of Veterans Affairs-funded Disrupted Care National Project. We analyzed abdominal aortic aneurysm (AAA) repair for intact aneurysms, carotid endarterectomy (CEA), and major lower extremity amputation (LEA) from 2018 to 2021. Each quarter of 2020 and 2021 was compared to its corresponding prepandemic quarter in 2019. We then performed a subanalysis of these trends by sex, age, and race. We identified 15,921 procedures: 3278 AAA repair, 6399 CEA, and 6244 LEA (Table, Figure). The average percent change during the baseline period from 2018 to 2019 was −4.3% for AAA repair, −8.5% for CEA, and −2.6% for LEA. Compared to Q2 of 2019, Q2 of 2020 demonstrated that AAA repair procedures decreased by 47%, CEA by 40%, and LEA by 14%. While procedures initially rebounded in Q3 of 2020, volumes did not return to their prepandemic baseline, demonstrating a persistent volume reduction (−16% AAA, −22% CEA, and −11% LEA). Thereafter, procedure counts again declined in Q4 of 2021(–42% AAA, −54% CEA, and −41% LEA). Despite the perception that vascular surgical care was singularly disrupted at the outset of the pandemic, there has been a sustained reduction in vascular surgical volume since 2019. Not only have procedure volumes not returned to pre-pandemic baseline, but it also appears that there has been a cumulative incremental impact on overall procedure volume. The impact of these findings on long term population health remain uncertain and necessitate a better understanding of postpandemic care delivery.TableChanges in procedure counts during selected quarters of the pandemic as compared to the baseline prepandemic rateAverage annual percent change (2018-2019)Procedure count Q2 2019Procedure count Q2 2020Percent changeProcedure count Q3 2019Procedure count Q3 2020Percent changeProcedure count Q4 2019Procedure count Q4 2021Percent changeIntact AAA repair−4.3%258137−46.9%221185−16.3%241141−41.5%CEA−8.5%474287−39.5%462360−22.1%423193−54.4%Major LEA−2.6%441381−13.6%423378−10.6%402236−41.3%AAA, Abdominal aortic aneurysm; CEA, carotid endarterectomy; LEA, lower extremity amputation.The baseline pre-pandemic count is defined as the corresponding quarter in 2019. Open table in a new tab