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Moore E, Wohlauer MV, Dorosh J, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff RF, Lucero L, Ali A, Koleilat I, Batarseh P, Talathi S, Rivera A, Humphries MD, Ly K, Harroun N, Smith BK, Darelli-Anderson AM, Choudhry A, Hammond E, Costanza M, Khetarpaul V, Cosentino A, Watson J, Afifi R, Mouawad NJ, Tan TW, Sharafuddin M, Quevedo JP, Nkansah R, Shibale P, Shalhub S, Lin JC. Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease. Vascular 2024:17085381241240679. [PMID: 38520224 DOI: 10.1177/17085381241240679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. METHODS The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. RESULTS A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78 days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. CONCLUSIONS Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.
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Affiliation(s)
- Ethan Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Dorosh
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| | - Mahmood Kabeil
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rafael D Malgor
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh A O'Banion
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Gabriel Lopez-Pena
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Riley Gillette
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert F Cuff
- Department of Surgery, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Leah Lucero
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Amna Ali
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Issam Koleilat
- Department of Surgery, RWJ/Barnabas Health, Toms River, NJ, USA
| | - Paola Batarseh
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Sonia Talathi
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Aksim Rivera
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Misty D Humphries
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kevin Ly
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Nikolai Harroun
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brigitte K Smith
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Asad Choudhry
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Eric Hammond
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Michael Costanza
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Vipul Khetarpaul
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Cosentino
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Watson
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nicolas J Mouawad
- Department of Vascular and Endovascular Surgery, McLaren Center for Research and Innovation, Bay City, MI, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mel Sharafuddin
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Judith P Quevedo
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Reggie Nkansah
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Palcah Shibale
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Sherene Shalhub
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Judith C Lin
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
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Tolaymat B, Chatterjee L, Lombardi JV, Tjaden BL, Batista PM, Carpenter JP, McMackin KK. Operative Case Volume for Vascular Integrated Residents and Fellows Following the Elective Surgery Shutdown due to COVID-19. Am Surg 2023; 89:6374-6377. [PMID: 37230492 PMCID: PMC10225800 DOI: 10.1177/00031348231177935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In response to the COVID-19 pandemic, nonemergent surgery was postponed in efforts to limit disease spread. To determine whether these changes affected vascular integrated resident (VR) and fellow (VF) operative volume, Accreditation Council for Graduate Medical Education (ACGME) case log data was reviewed. Case volume and standard deviation for each major category was for graduates of 2020 and 2021 were compared to the year prior to the pandemic, 2019. There were only 3 significant changes when comparing 2020/2021 to the prepandemic baseline of 2019, with increase in abdominal obstructive cases for VRs (8.1 in 2021 vs 5.9 in 2019, P = .021), an increase in upper extremity cases for VFs (18.9 in 2021 from 15.8 in 2019, P = .029), and a decrease in venous cases for VFs (39.6 in 2021 from 48.4 in 2019, P = .011). Postponing nonemergent surgery did not translate to significant changes in operative cases for graduating VRs and VFs.
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Affiliation(s)
- Besher Tolaymat
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
| | | | - Joseph V. Lombardi
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
| | - Bruce L. Tjaden
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
| | - Philip M. Batista
- Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
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Kabeil M, Wohlauer MV, D'Oria M, Khetarpaul V, Gillette R, Moore E, Colborn K, Cuff RF, O'Banion LA, Koleilat I, Aziz F, Mouawad NJ. Carotid Artery Operation Delay During the Covid-19 Pandemic: Results of a Multicenter International Study. Ann Vasc Surg 2023; 96:44-56. [PMID: 37355018 DOI: 10.1016/j.avsg.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/09/2023] [Accepted: 05/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND To measure the impact of the COVID-19 pandemic on the management of patients with carotid artery stenosis. METHODS We prospectively collected data from 25 centers (19 centers in the United States and 6 centers internationally) on postponed carotid artery operations between March 2020 and January 2022. We describe the characteristics of these patients and their planned operations, along with outcomes including mortality and neurological deterioration during the period of operative delay due to the COVID-19 pandemic. RESULTS A total of 1,220 vascular operations were postponed during the pandemic, of them 96 patients presented with significant carotid stenosis (median stenosis of 71%; interquartile range; 70-80) and 80% of them were planned for carotid endarterectomy. Most patients were asymptomatic (69%), and 31% of patients were symptomatic (16% of patients had a stroke, 15% of patients had a transient ischemic attack, and 1% of patients experienced amaurosis fugax). The median length of surgical delay was 71 days (interquartile range: 45.5, 115.5). At the data entry time, 62% of patients had their carotid operations postponed and successfully completed. Most postponements (72%) were due to institutional policies aimed at resource conservation. During the delay, no patient decompensated or required an urgent operation. A total of 5 patients (5%) with carotid stenosis died while awaiting operations due to COVID-19. CONCLUSIONS Our study of a cohort of patients with carotid artery stenosis who underwent a median delay of 71 days during the COVID-19 pandemic showed a disparate operation delay between US regions and internationally, most postponements were due to hospital policy, and none of the patients deteriorated or required an emergency surgery during the delay.
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Affiliation(s)
- Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Max V Wohlauer
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Vipul Khetarpaul
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Riley Gillette
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ethan Moore
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Leigh Ann O'Banion
- Department of Surgery, University of California San Francisco (UCSF) Fresno, Fresno, CA
| | - Issam Koleilat
- Department of Surgery, RWJBH Community Medical Center, Toms River, NJ
| | - Faisal Aziz
- Division of Vascular Surgery, Department of Surgery, Penn State University, State College, PA
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Bozzani A, Arici V, Ticozzelli G, Franciscone MM, Sterpetti AV, Ragni F. Increased rates of ruptured abdominal aortic aneurysm during the COVID-19 pandemic. J Vasc Surg 2021; 74:2119-2120. [PMID: 34809819 PMCID: PMC8828365 DOI: 10.1016/j.jvs.2021.07.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/31/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio V Sterpetti
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Arici V, Franciscone M, Ticozzelli G, Sterpetti AV, Ragni F. COVID-19 patients with abdominal aortic aneurysm may be at higher risk for sudden enlargement and rupture. J Vasc Surg 2021; 75:387-388. [PMID: 34774979 PMCID: PMC8582098 DOI: 10.1016/j.jvs.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | | | - Giulia Ticozzelli
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Antonio V Sterpetti
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS San Matteo, Pavia, Italy
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Gupta R, Mouawad NJ, Yi JA. The impact of the COVID-19 pandemic on vascular surgery: Health care systems, economic, and clinical implications. Semin Vasc Surg 2021; 34:74-81. [PMID: 34642039 PMCID: PMC8285216 DOI: 10.1053/j.semvascsurg.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus-2 (coronavirus disease 2019 [COVID-19]) pandemic is responsible for more than 500,000 deaths in the United States and nearly 3 million worldwide, profoundly altering the landscape of health care delivery. Aggressive public health measures were instituted and hospital efforts became directed at COVID-19–related concerns. Consequently, routine surgical practice was virtually halted, resulting in billions of dollars in hospital losses as pandemic costs escalated. Navigating an uncertain new landscape of scarce resource allocation, exposure risk, role redeployment, and significant practice pattern changes has been challenging. Furthermore, the overall effect on the financial viability of the health care system and vascular surgical practices is yet to be elucidated. This review explores the economic and clinical implications of COVID-19 on the practice of vascular surgery in addition to the health care system as a whole.
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Affiliation(s)
- Ryan Gupta
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, 12631 E. 16(th) Avenue, Room 5405 MC C312, Aurora, CO, 80045
| | - Nicolas J Mouawad
- Division of Vascular and Endovascular Surgery, McLaren Health System-Bay Region, Auburn Hills, MI; Department of Surgery, Michigan State University, East Lansing, MI
| | - Jeniann A Yi
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, 12631 E. 16(th) Avenue, Room 5405 MC C312, Aurora, CO, 80045.
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Lee KS, Ranganathan S, Choong AMTL, Ng JJ. A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic. Semin Vasc Surg 2021; 34:63-73. [PMID: 34642038 PMCID: PMC8349480 DOI: 10.1053/j.semvascsurg.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgical procedures. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional, and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anesthesia, delayed presentation of vascular surgery conditions, and poorer outcomes of patients with chronic limb threatening ischemia. This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.
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Affiliation(s)
- Keng Siang Lee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Bristol Medical School, University of Bristol, Bristol, UK; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Sruthi Ranganathan
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, UK; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, UK; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, UK; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
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Drudi LM, Nishath T, Ma X, Mouawad NJ, O'Banion LA, Shalhub S. The impact of the COVID-19 pandemic on wellness among vascular surgeons. Semin Vasc Surg 2021; 34:43-50. [PMID: 34144747 PMCID: PMC9710729 DOI: 10.1053/j.semvascsurg.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed significant strain on the health and welfare of all health care professionals, including vascular surgeons. This review summarizes the implications of the pandemic on the health and wellness of surgeons and trainees, with a particular focus on those in vascular surgery (VS). A literature review was completed using common resource databases. We provide a brief history of burnout in VS and explore burnout and wellness in VS during this unprecedented pandemic. We then offer recommendations to address mental health needs by the VS workforce and highlight opportunities to address the gaps in the literature. The impact of COVID-19 on the professional and personal lives of surgeons and trainees in VS is notable. More than half of vascular surgeons reported some degree of anxiety. Factors associated with anxiety and burnout include COVID-19 exposure, moral injury, practice changes, and financial impacts. Trainees appeared to have more active coping strategies with dampened rates of anxiety compared to those in practice. Women appear to be disproportionately affected by the pandemic, with higher rates of anxiety and burnout. Groups underrepresented in medicine seemed to have more resilience when it came to burnout, but struggled with other inequities in the health care environment, such as structural racism and isolation. Strategies for addressing burnout include mindfulness practices, exercise, and peer and institutional support. The COVID-19 pandemic has had a substantial mental health impact on the VS workforce globally, as shifts were made in patient care, surgical practice, and work-home life concerns.
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Affiliation(s)
- Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Thamanna Nishath
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Xiya Ma
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, University of California San Francisco–Fresno, Fresno, CA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195,Corresponding author
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