Abstract
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.
Original language | English |
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Pages (from-to) | 630-635 |
Number of pages | 6 |
Journal | Annals of Surgery |
Volume | 273 |
Issue number | 4 |
Early online date | 23 Dec 2020 |
DOIs | |
Publication status | Published - 1 Apr 2021 |
Bibliographical note
Funding Information:From the Institute of Cancer and Genomics, University of Birmingham, Birming-ham, United Kingdom and Newcastle upon Tyne, United Kingdom. [email protected]. The Vascular and Endovascular Research Network COVER Study Collaborative* *A complete list of the investigators is included in supplementary material (Appendix 1, http://links.lww.com/SLA/C860). ISRCTN registration reference: 80453162 (registered in April 2020). 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). The authors declare no conflict of interests. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsofsurgery.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/20/27304-0630 DOI: 10.1097/SLA.0000000000004722
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Research Groups and Themes
- Covid19