key: cord-0849222-2m38duq4
authors: Schuivens, Puck M.E.; Buijs, Manon; Boonman-de Winter, Leandra; Veen, Eelco J.; de Groot, Hans F.W.; Buimer, Thijs G.; Ho, Gwan H.; van der Laan, Lijckle
title: Impact of the COVID-19 lock down strategy on vascular surgery practice: more major amputations than usual
date: 2020-08-04
journal: Ann Vasc Surg
DOI: 10.1016/j.avsg.2020.07.025
sha: 5792d4a683183d102af256c7e8bbbc520e40e888
doc_id: 849222
cord_uid: 2m38duq4

OBJECTIVES: To investigate the impact of the COVID-19 lockdown period on the number and type of vascular procedures performed in the operating theatre. METHODS: 38 patients that underwent 46 vascular procedures during the lockdown period of March 16th until April 30th, 2020 were included. The control groups consisted of 29 patients in 2019 and 54 patients in 2018 that underwent respectively 36 and 66 vascular procedures in the same time period. Data was analysed with SPSS statistics. RESULTS: Our study shows that the lockdown during the COVID-19 pandemic resulted in a significant increase in number of major amputations (42% in 2020 vs 18% and 15% in 2019 and 2020 respectively; p-value .019). Furthermore, we observed a statistically significant difference in the degree of tissue loss as categorized by the Rutherford classification (p-value .007). During the lockdown period patients presented with more extensive ischemic damage when compared to previous years. We observed no difference in vascular surgical care for patients with an aortic aneurysm. CONCLUSION: Measurements taken during the lockdown period have a significant effect on non-COVID-19 vascular patient care, which leads to an increased severe morbidity. In the future policymakers should be aware of the impact of their measurements on vulnerable patient groups like patients with peripheral arterial occlusive disease. For these patients medical care should be easily accessible and adequate.

Results 45

Our study shows that the lockdown during the COVID-19 pandemic resulted in a significant 46 increase in number of major amputations (42% in 2020 vs 18% and 15% in 2019 and 2020 47 respectively; p-value .019). Furthermore, we observed a statistically significant difference in 48 the degree of tissue loss as categorized by the Rutherford classification (p-value .007). During 49 the lockdown period patients presented with more extensive ischemic damage when 50 compared to previous years. We observed no difference in vascular surgical care for patients 51 with an aortic aneurysm. 52

Conclusion 53

In December 2019, a new cluster of pneumonia was reported in Wuhan, China, which 63 was linked to a novel coronavirus on January 7 th , 2020 1 . This severe acute respiratory 64 syndrome coronavirus-2 (SARS-CoV-2) spread rapidly and on January 30th the World Health 65

Organization declared a public health emergency of international concern 2 . In the 66 Netherlands, the first infection was confirmed on February 27th, 2020. A week later, on 67

March 3rd, the first patient tested positive at our hospital. In the following days the number of 68 infections increased, which led to an intelligent lockdown on March 16th, 2020. At that 69 moment 184 patients with SARS-CoV-2 infection were admitted to the hospital in the 70 For patients with chronic peripheral arterial occlusive disease the Rutherford 103 classification system was used to record the extent of the disease 7 . Rutherford V (minor tissue 104 loss) and VI (major tissue loss) were classified as one category (tissue loss), because 105 categorizing the difference between both categories retrospectively from patient records could 106 not be done objectively. 107

Our research was approved by the local review board of the Amphia Hospital. 108

Descriptive statistics were used to present baseline characteristics and outcome 118 Rutherford grade V/VI (90%) was significantly higher during the lockdown period, whereas 138 the number of patients presenting with Rutherford grade III (5%) peripheral arterial occlusive 139 disease was significantly lower (p-value = 0.007). There was no significant difference in the 140 number of patients presenting with ischemia due to a diabetic foot (table III) (table III) . Of all major amputations performed in our study population only two were 152 performed for acute limb ischemia, both in the 2020 cohort (2/15). 153 154

During the COVID-19 lockdown period, 10 patients underwent surgery for an aortic 156 aneurysm. We observed no differences for aortic surgery in the different periods (table IV) . Values are numbers (percentages) unless stated otherwise 5 *Chi-square test with Bonferroni correction 6 † p-value <.05 7 ‡ Statistically significant difference between observed number of patients in 2020 and 2019 8 § The observed number of patients in 2020 differs significantly from 2019 and 2018 9 J o u r n a l P r e -p r o o f ‡ statistically significant difference between observed numbers 2020 and 2018 13 

The epidemiology and 210 clinical information about COVID-19

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Rijksinstituut voor Volksgezondheid en Milieu. Epidemiologische situatie COVID-19

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An increased severity of peripheral arterial disease in the COVID-221

Nederlandse vereniging voor Heelkunde. Handvat voor chirurgische ingrepen tijdens 223

Corona crisis