Outcomes After Vascular Surgery Procedures in Patients with COVID-19 Infection: A National Multicenter Cohort Study (COVID-VAS)

Ann Vasc Surg . 2021 May;73:86-96. doi: 10.1016/j.avsg.2021.01.054. Epub 2021 Jan 22.

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)

PMID

PMID: 33493590
PMCID: PMC7825929
DOI: 10.1016/j.avsg.2021.01.054

Affiliations

¹Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain. Electronic address: esannorberto@hotmail.com.

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.

Abstract

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.