Fecha de la publicación: 22/01/2021
Autor: E M San Norberto (1), J De Haro (2), R Peña (3), L Riera (4), D Fernández-Caballero (5), A Sesma (6), P Rodríguez-Cabeza (7), M Ballesteros (8), E Gómez-Jabalera (9), G T Taneva (10), C Aparicio (11), N Moradillo (12), I Soguero (13), A M Badrenas (14), R Lara (15), A Torres (16), V A Sala (17), C Vaquero (18), COVID-VAS Investigators from the Vascular Investigation Network (RIV) of the Spanish Society of Angiology and Vascular Surgery (SEACV)
1Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain. Electronic address: firstname.lastname@example.org.
2Department of Vascular Surgery, Getafe University Hospital, Madrid, Spain.
3Department of Vascular Surgery, Salamanca University Hospital, Salamanca, Spain.
4Department of Vascular Surgery, La Paz University Hospital, Madrid, Spain.
5Department of Vascular Surgery, Torrejón University Hospital, Madrid, Spain.
6Department of Vascular Surgery, Álava. University Hospital, Álava, Spain.
7Department of Vascular Surgery, Dr. Josep Trueta University Hospital, Gerona, Spain.
8Department of Vascular Surgery, León University Hospital, León, Spain.
9Department of Vascular Surgery, Nostra Senyora de Meritxell Hospital, Andorra.
10Department of Vascular Surgery, HM Hospitals, Madrid, Spain.
11Department of Vascular Surgery, Jiménez Diaz Foundation University Hospital, Madrid, Spain.
12Department of Vascular Surgery, Burgos University Hospital, Burgos, Spain.
13Department of Vascular Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
14Department of Vascular Surgery, Xarxa Assistencial Universitària Manresa, Barcelona, Spain.
15Department of Vascular Surgery, Son Espases University Hospital, Palma de Mallorca, Spain.
16Department of Vascular Surgery, La Fe University Hospital, Valencia, Spain.
17Department of Vascular Surgery, Clinic University Hospital, Valencia, Spain.
18Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
Objectives: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic.
Methods: This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across Spain and Andorra between March and May 2020. The primary end point was 30-day mortality. Clinical Trials registry number NCT04333693.
Results: The mean age was 70.9 (45-94) and 58 (77.0%) patients were male. Around 70.7% had postoperative complications, 36.0% of patients experienced respiratory failure, 22.7% acute renal failure, and 22.7% acute respiratory distress syndrome (ARDS). All-cause 30-days mortality rate was 37.3%. Multivariate analysis identified age >65 years (P = 0.009), American Society of Anesthesiologists (ASA) classification IV (P = 0.004), preoperative lymphocyte count <0.6 (×109/L) (P = 0.001) and lactate dehydrogenase (LDH) >500 (UI/L) (P = 0.004), need for invasive ventilation (P = 0.043), postoperative acute renal failure (P = 0.001), ARDS (P = 0.003) and major amputation (P = 0.009) as independent variables associated with mortality. Preoperative coma (P = 0.001), quick Sepsis Related Organ Failure Assessment (qSOFA) score ≥2 (P = 0.043), lymphocytes <0.6 (×109/L) (P = 0.019) leucocytes >11.5 (×109/L) (P = 0.007) and serum ferritin >1800 mg/dL (P = 0.004), bilateral lung infiltrates on thorax computed tomography (P = 0.025), and postoperative acute renal failure (P = 0.009) increased the risk of postoperative ARDS. qSOFA score ≥2 was the only risk factor associated with postoperative sepsis (P = 0.041).
Conclusions: Patients with COVID-19 infection undergoing vascular surgery procedures showed poor 30-days survival. Age >65 years, preoperative lymphocytes <0.6 (x109/L) and LDH >500 (UI/L), and postoperative acute renal failure, ARDS and need for major amputation were identified as prognostic factors of 30-days mortality.
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