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Outcomes of vascular and endovascular interventions performed during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 2 study

journal contribution
posted on 06.01.2021, 16:04 by Ruth A. Benson, Sandip Nandhra, The Vascular and Endovascular Research NetworkVERN COVER Study Collaborative
Objective:
The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic.

Background data:
During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions.

Methods:
An international multi-centre observational study of outcomes following open and endovascular interventions.

Results:
In an analysis of 1,103 vascular intervention (57 centres in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 ± 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0%. (aortic interventions mortality 15.2% [23/151], amputations 12.1% [28/232], carotid interventions 10.7% [11/103], lower limb revascularisations 9.8% [51/521]). Chronic obstructive pulmonary disease (Odds ratio [OR] 2.02, 95% CI 1.30–3.15) and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57–241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22–0.73 and 0.60, 95% CI 0.45–0.98 respectively. After adjustment, antiplatelet (Odds Ratio [OR] 0.503, 95% Confidence Interval [CI]:0.273 - 0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205 - 0.824) were linked to reduced risk of in-hospital mortality.

Conclusions:
Mortality following vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause e.g. recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.

Funding

The study has received financial grant support from the Circulation Foundation (no grant reference). The National Institute for Health Research (NIHR) has provided salary support for the co-chief investigators (reference: NIHR000359).

History

Author affiliation

Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

Annals of Surgery

Publisher

Lippincott, Williams & Wilkins

issn

0003-4932

Acceptance date

02/11/2020

Copyright date

2020

Available date

23/12/2021

Language

en