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Clinical and economic impact of COVID in Vascular Surgery at a Tertiary University 'Hub' Hospital of Italy. Ann Vasc Surg 2022; 83:97-107. [PMID: 35247541 PMCID: PMC8889731 DOI: 10.1016/j.avsg.2022.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/22/2022]
Abstract
Background Since the first cases of a novel respiratory disease were reported in December 2019, coronavirus disease (COVID-19) Emergency State (Cov-ES) caused a worldwide outbreak requiring a complete reorganization of the healthcare system and new management of its personnel; aim of this study was to analyze the clinical and financial impact of Cov-ES in the Department of Vascular Surgery at a Tertiary University “Hub” Hospital in northeast Italy. Methods Differences in clinical practice according to Diagnostic Related Group (DRG) and International Statistical Classification of Diseases (ICD) and Related Health Problems and the financial impact of Cov-ES were considered. Vascular procedures performed between March 2019 and December 2019 (Prepandemic) were compared to those performed in the period March–December 2020 (Pandemic). Prepandemic and pandemic reimbursements of all vascular activities and the top 3 vascular diagnoses were evaluated. Results Prepandemic versus pandemic era documented a decrease of vascular consultations performed (2,882 vs. 2,270, −21.2%). The number of total vascular procedures decreased from 997 to 797 (−20.1%) with a higher reduction observed in outpatient surgical activities (247 to 136, −45.0%, P = 0.0005) rather than inpatient surgical activities (750 vs. 661, 11.9%, P = 0.02). Length of hospital stay (LOS) increased from 3.3 ± 2.7 days in prepandemic to 5.3 ± 3.9 in the pandemic era (P = 0.004). Among patients with limb-threatening ischemia, the rate of major limb amputation was higher in the pandemic (3.3% vs. 5.4%, respectively, P = 0.02), and a higher rate of elective hospitalization procedures was performed as urgent/emerging setting after clinical deterioration (2.8 % vs. 6.4%, P = 0.0002). According to DRG classification, an increase of “complicated” limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) was observed prepandemic to pandemic (+84.2% and +25.0%, respectively). Total reimbursement for vascular activities between pandemic versus prepandemic was 4,646,108€ vs. 5,054,398€, respectively (−8.0%). Management of “complicated” limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) required a higher clinical and financial support that was translated into higher economic reimbursement during the pandemic (273,035€ vs. 150,005€, +82.0% and 749,250€ vs. 603,680€, +24.1%, respectively). Conclusions During the pandemic, the main resources were employed for the treatment of limb-threatening ischemia, aortic aneurysm, and carotid stenosis. Inpatient activities documented an increase in major limb amputation and LOS. An increased reimbursement for each vascular procedure and for all “complicated” diagnoses revealed that the more serious and resource-demanding pathology occurred in this period.
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de Beaufort HWL, Roefs MM, Daeter EJ, Heijmen RH. Impact of the coronavirus disease 2019 pandemic on volume of thoracic aortic surgery on a national level. Eur J Cardiothorac Surg 2022; 61:854-859. [PMID: 34986237 PMCID: PMC8755400 DOI: 10.1093/ejcts/ezab550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/14/2022] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Edgar J Daeter
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands.,Netherlands Heart Registration, Utrecht, Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
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Gopalakrishnan A, Kamanakeri D, Anoop A, Harikrishnan S. Ascending aortic dissecting aneurysm with rupture into the right atrium associated with COVID-19. J Postgrad Med 2022; 68:117-119. [PMID: 35417997 PMCID: PMC9196298 DOI: 10.4103/jpgm.jpgm_903_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases. CARDIOLOGY DISCOVERY 2021; 1:233-258. [PMID: 34888547 PMCID: PMC8638821 DOI: 10.1097/cd9.0000000000000038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely ranks among the deadliest diseases in human history. As with other coronaviruses, SARS-CoV-2 infection damages not only the lungs but also the heart and many other organs that express angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2. COVID-19 has upended lives worldwide. Dietary behaviors have been altered such that they favor metabolic and cardiovascular complications, while patients have avoided hospital visits because of limited resources and the fear of infection, thereby increasing out-hospital mortality due to delayed diagnosis and treatment. Clinical observations show that sex, age, and race all influence the risk for SARS-CoV-2 infection, as do hypertension, obesity, and pre-existing cardiovascular conditions. Many hospitalized COVID-19 patients suffer cardiac injury, acute coronary syndromes, or cardiac arrhythmia. SARS-CoV-2 infection may lead to cardiomyocyte apoptosis and necrosis, endothelial cell damage and dysfunction, oxidative stress and reactive oxygen species production, vasoconstriction, fibrotic and thrombotic protein expression, vascular permeability and microvascular dysfunction, heart inflammatory cell accumulation and activation, and a cytokine storm. Current data indicate that COVID-19 patients with cardiovascular diseases should not discontinue many existing cardiovascular therapies such as ACE inhibitors, angiotensin receptor blockers, steroids, aspirin, statins, and PCSK9 inhibitors. This review aims to furnish a framework relating to COVID-19 and cardiovascular pathophysiology.
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Bissacco D, Lomazzi C, Buongiovanni G, Magni A, Domanin M, Casana R, Bismuth J, van Herwaarden JA, Upchurch GR, Trimarchi S. COVID-19 and aortic disease: a practical systematic review of the literature on management and outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:527-534. [PMID: 34581554 DOI: 10.23736/s0021-9509.21.12049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the advent of the 2019 coronavirus (COVID-19) outbreak, vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19 negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19 positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19 negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decisionmaking especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Agnese Magni
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Renato Casana
- Vascular Surgery Unit, IRCCS Auxologico, Milan, Italy
| | - Jean Bismuth
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Juraszek A, Czerny M, Rylski B. Update in aortic dissection. Trends Cardiovasc Med 2021; 32:456-461. [PMID: 34411744 DOI: 10.1016/j.tcm.2021.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 01/16/2023]
Abstract
New concepts regarding the diagnosis, classification, and treatment of aortic dissection have been recently developed. The aim of this paper is to describe the current state of knowledge on this subject and discuss any controversies surrounding it. Novel findings in the patho mechanisms of aortic dissection have evolved focusing on the indications for preventive surgery, biomarkers, and four-dimensional (4D)-flow magnetic resonance imaging. New classifications of aortic dissections have been proposed (TEM, STS/SVS). Finally, recent treatment improvements in aortic dissection treatment options have been presented, i.e., the frozen elephant trunk approach, thoracic endovascular repair, and the endo-Bentall concept as a future option.
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Affiliation(s)
- Andrzej Juraszek
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Bissacco D, Franchin M, Piffaretti G, Luzzani L, D'Oria M, Casana R, Domanin M, Bellosta R, Trimarchi S. Impact of COVID-19 on aortic operations. Semin Vasc Surg 2021; 34:37-42. [PMID: 34144746 PMCID: PMC8133823 DOI: 10.1053/j.semvascsurg.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has profoundly affected all aspects of medicine and surgery. Vascular surgery practice and interventions were also forced to change in order to deal with new COVID-19–related priorities and emergencies. In this setting, difficulties in aortic disease management were two-fold: new vascular complications related to COVID-19 infection and the need to guarantee prompt and correct treatment for the general “non-COVID-19” population. Furthermore, discomfort deriving from precautions to minimize the risk of virus transmission among patients and among health care professionals, the need to separate COVID-19–positive from COVID-19–negative patients, and the high incidence of postoperative complications in COVID-19 cases created a challenging scenario for cardiac operations. The aim of this review was to provide evidence derived from the published literature (case reports, case series, multicenter experience, and expert opinion) on the impact of the COVID-19 outbreak on aortic vascular surgery services and interventions, describing COVID-19–related findings, intraoperative and postoperative outcomes, as well as the impact of the COVID-19 outbreak on noninfectious aortic patients.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy.
| | - Marco Franchin
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy; Vascular Surgery Unit, Azienda Socio Sanitaria Territoriale Settelaghi, Varese, Italy
| | - Luca Luzzani
- Vascular Surgery Unit, Poliambulanza Foundation, Brescia, Italy
| | - Mario D'Oria
- Vascular Surgery Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Renato Casana
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Auxologico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | | | - Santi Trimarchi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Der erste Einschlag und Kollateralschäden der Corona-Pandemie in der interdisziplinären Gefäßmedizin: Impfkampagnen für Patienten mit peripherer arterieller Verschlusskrankheit? GEFÄSSCHIRURGIE 2021; 26:151-153. [PMID: 33942001 PMCID: PMC8080858 DOI: 10.1007/s00772-021-00769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 10/30/2022]
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Impact of the COVID-19 outbreak on hospitalizations and outcomes in patients with acute myocardial infarction in a Japanese Single Center. Heart Vessels 2021; 36:1474-1483. [PMID: 33743048 PMCID: PMC7980755 DOI: 10.1007/s00380-021-01835-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 12/25/2022]
Abstract
There are a few Japanese data regarding the incidence and outcomes of acute myocardial infarction (AMI) after the coronavirus disease 2019 (COVID-19) outbreak. We retrospectively reviewed the data of AMI patients admitted to the Nihon University Itabashi Hospital after a COVID-19 outbreak in 2020 (COVID-19 period) and the same period from 2017 to 2019 (control period). The patients’ characteristics, time course of admission, diagnosis, and treatment of AMI, and 30-day mortality were compared between the two period-groups for both ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), respectively. The AMI inpatients decreased by 5.7% after the COVID-19 outbreak. There were no differences among most patient backgrounds between the two-period groups. For NSTEMI, the time from the symptom onset to admission was significantly longer, and that from the AMI diagnosis to the catheter examination tended to be longer during the COVID-19 period than the control period, but not for STEMI. The 30-day mortality was significantly higher during the COVID-19 period for NSTEMI (23.1% vs. 1.9%, P = 0.004), but not for STEMI (9.4% vs. 8.3%, P = 0.77). In conclusion, hospitalizations for AMI decreased after the COVID-19 outbreak. Acute cardiac care for STEMI and the associated outcome did not change, but NSTEMI outcome worsened after the COVID-19 outbreak, which may have been associated with delayed medical treatment due to the indirect impact of the COVID-19 pandemic.
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