O-183 - SCANDINAVIAN EVALUATION OF THE COVID-19 PANDEMIC'S IMPACT ON VASCULAR SURGICAL INTERVENTIONS DURING DIFFERENT ACTION STRATEGIES. - A SCANDINAVIAN VASCULAR BENCHMARK REPORT, WITHIN THE VASCUNET GROUP

TOPIC:
Other
AUTHORS:
Sinabulya H. (Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ~ Stockholm ~ Sweden) , Kragsterman B. (Department of Vascular Surgery, Västmanland County Hospital Västerås, Västerås, Sweden; Department of Surgical Science, Uppsala University, Uppsala, Sweden. ~ Västerås ~ Sweden) , Sigvant B. (School of Medical Sciences, Örebro University, Örebro, Department of Surgical Sciences, Uppsala University, Uppsala ~ Örebro ~ Sweden) , Budtz-Lilly J. (Department of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark. ~ Aarhus ~ Denmark) , Altreuther M. (Department of Surgery, St Olavs Hospital, Trondheim, Norway. ~ Trondheim ~ Norway)
Introduction:
On March 11, 2020, the World Health Organization (WHO) announced Covid-19 a pandemic (1). By mid-November 2021, 255M cases were confirmed globally and 5.12M deaths (2). The Scandinavian countries, with otherwise similar economic and social policies, differed in strategies to slow the virus spread. Denmark and Norway introduced strict interventions such as closing schools and businesses as well as travel restrictions while Sweden was less strict, and measures relied on trust and individual responsibility. In a stringency index, based on nine governmental interventions (low to high), Sweden, Norway and Denmark scored; 33, 63 and 63 respectively. Guidelines for decision-making triage were developed with strategies that involve varying restructuring of healthcare with reprioritizations of surgical indications(3, 4). However, the extent of the changes in health care with respect to the vascular surgery procedures and possible consequences, in relation to pronounced different action strategies has not previously been evaluated. This study aims to map how vascular surgical volume and surgical indication have been affected during the Covid-19 pandemic in the Scandinavian countries by using national quality registry data.
Methods:
This study is a retrospective cohort-study based on national quality registries for vascular surgery in Denmark, Norway, and Sweden. The target population includes all males or females registered for a surgical procedure due to abdominal aortic aneurysm (AAA), lower extremity arterial disease (LEAD), or symptomatic carotid artery stenosis (CAS) between January 2018 (-December 2019, (pre- pandemic)) and (January 2020 -) December 2020 (per pandemic). Total volumes for AAA, LEAD and CAS were collected for all countries and means were compared. Further statistical analysis for AAA was done to compare aortic diameter of elective cases, for LEAD analyses were done for number of patients with acute limb ischemia, claudication, and critical limb ischemia. CAS analysis focused on time to surgery from first symptoms.
Results:
The registered volumes per 100 000 people aged over 60 years for AAA in the included Scandinavian countries are shown in figure 1. In the same figure we can see the mean diameters for both ruptured and non-ruptured aneurysms. Denmark tends to have an increasing total number of aneurysm procedures both before and during the pandemic (819 cases 2018 and 994 cases in 2020) and an increasing number of ruptured cases (209 in 2018 and 272 in 2020). The mean aortic diameter for registered elective cases is almost unchanged for all countries pre- and per-pandemic. Whereas for cases registered as ruptured the mean aortic diameter has tended to decrease in Sweden over the years (73 mm 2018 and 71 mm in 2020). This has not been the case for Norway with an increasing mean diameter of 70 mm in 2018 and 73 mm in 2020. On analysis of overall volume for patients with LEAD in Sweden, there was a slight increase in registered cases from a mean total of 5562 cases pre-pandemic to 6153 cases in 2020. A similar increase was seen in Denmark while no major changes were observed in Norway (3305,5 and 3159 in 2020). Indication for surgery differed pre- and per-pandemic, a decrease for procedures for intermittent claudication was observed in Sweden and Denmark, - 27% (95%CI, 1,606.5 - 1,618.2) and -18% (95%CI, 1,185.3 - 1,192.7) respectively. The percentages for acute limb ischemia were unchanged in all countries. Procedures for critical limb threatening ischemia increased by 33% (95%CI, 3,323.1 - 3,340.1) in Sweden, by 13% in Denmark an 2 % in Norway (table 1). For CAS, overall volumes showed that Denmark had an increase of 17% (95%CI, 480.2 - 484.5) registered cases. Whereas Norway had an opposite decrease with -17% (95%CI, 403.1 - 406.9) and Sweden had unchanged volumes. The median number of days from qualifying event to operation was unchanged for the different countries. Norway had a median number of 8 days, Denmark 11, and Sweden 7.
Conclusion:
The Scandinavian initial response to the Covid-19 pandemic did rather increase the overall vascular procedure volumes. Fewer patients with intermittent claudication were offered interventions, in favor of critical limb threatening ischemia. No changes in aortic diameter were shown pre-versus per- pandemic. Despite heterogeneity in Covid interventions, there were no major differences shown in the Scandinavian operating rooms.
References:
1. Coronavirus disease 2019 (‎COVID-19)‎: situation report, 51. iris; 2020. 2. Coronavirus Pandemic (COVID-19) - the data. 2021. 3. COVID-19: Recommendations for Management of Elective Surgical Procedures. American Collage of Surgeons; 2020. 4. Clinical guide to surgical prioritisation during the coronavirus pandemic. Royal Collage of Surgeons of England; 2020.
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