Outcomes of vascular and endovascular interventions performed during the coronavirus disease 2019 (covid-19) pandemic the vascular and endovascular research network (vern) covid-19 vascular service (cover) tier 2 study

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-center observational study of outcomes after open and endovascular interventions. Results: In an analysis of 1103 vascular intervention (57 centers 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% confidence interval (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 (OR 0.503, 95% 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 after vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause, for example, recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.