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The Journal of Cardiovascular Surgery 2021 February;62(1):71-8

DOI: 10.23736/S0021-9509.20.11564-7


language: English

Differences in hub and spoke vascular units practice during the novel Coronavirus-19 (COVID-19) outbreak in Lombardy, Italy

Raffaello BELLOSTA 1, Daniele BISSACCO 2, Giovanni ROSSI 3, Stefano PIRRELLI 4, Gaetano LANZA 5, Dalmazio FRIGERIO 6, Roberto CHIESA 7, Patrizio CASTELLI 8, Stefano BONARDELLI 9, Santi TRIMARCHI 2, 10 , The Vascular Surgery Group of Regione Lombardia (VSG-RL) registry participants 

1 Unit of Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy; 2 Unit of Vascular Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3 Unit of Vascular Surgery, Cardiovascular Department, Alessandro Manzoni Hospital, Lecco, Italy; 4 Unit of Vascular Surgery, Cardio-Thoraco-Vascular Department, Carlo Poma Hospital, Mantua, Italy; 5 Unit of Vascular Surgery, IRCCS Multimedica, Castellanza, Varese, Italy; 6 Unit of Vascular Surgery, Hospital of Vimercate, Vimercate, Monza-Brianza, Italy; 7 Unit of Vascular Surgery, Vita Salute San Raffaele University, Milan, Italy; 8 Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy; 9 Unit of Vascular Surgery, Department of Surgery, Spedali Civili University Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy; 10 Unit of Vascular Surgery, Department of Clinical and Community Sciences, University of Milan, Milan, Italy

BACKGROUND: To highlight differences in clinical practice among referral (hub, HH) or satellite (spoke, SH) hospital vascular surgery units (VSUs) in Lombardy, during the COVID-19 pandemic “phase 1” period (March 8 - May 3, 2020).
METHODS: The Vascular Surgery Group of Regione Lombardia Register, a real-word, multicenter, retrospective register was interrogated. All patients admitted with vascular disease were included. Patients’ data on demographics, COVID-19 positivity, comorbidities and outcomes were extrapolated. Two cohorts were obtained: patients admitted to HH or SH. Primary endpoint was 30-day mortality rate. Secondary outcomes were 30-day complications and amputation (in case of peripheral artery disease [PAD]) rates. Univariate and multivariate analysis were used to compare HH and SH groups and predictors of poor outcomes.
RESULTS: During the study period, 659 vascular patients in 4 HH and 27 SH were analyzed. Among these, 321 (48.7%) were admitted to a HH. No difference in COVID-19 positive patients was described (21.7% in HH vs. 15.9% in SH; P=0.058). After 30 days from intervention, HH and SH experienced similar mortality and no-intervention-related complication rate (12.1% vs. 10.0%; P=0.427 and 10.3% vs. 8.3%; P=0.377, respectively). Conversely, in HH postoperative complications were higher (23.4% vs. 16.9%, P=0.038) and amputations in patients treated for PAD were lower (10.8% vs. 26.8%; P<0.001) than in SH. Multivariate analysis demonstrated in both cohorts COVID-19-related pneumonia as independent predictor of death and postoperative complications, while age only for death.
CONCLUSIONS: HH and SH ensured stackable results in patients with vascular disease during COVID-19 “phase 1.” Despite this, poor outcomes were observed in both HH and SH cohorts, due to COVID-19 infection and its related pneumonia.

KEY WORDS: COVID-19; Vascular surgical procedures; Multicenter registry; Emergencies

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