The impact of the pandemic for COVID-negative vascular patients: analysis from the Italian epicenter.

Autor:	Civilini E; Unit of Vascular Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy - efrem.civilini@hunimed.eu.; Humanitas University, Pieve Emanuele, Milan, Italy - efrem.civilini@hunimed.eu., Pascucci MG; Humanitas University, Pieve Emanuele, Milan, Italy.; University of Insubria, Varese, Italy 4 Vita-Salute San Raffaele University, Milan, Italy., Baronetto N; Humanitas University, Pieve Emanuele, Milan, Italy.; University of Insubria, Varese, Italy 4 Vita-Salute San Raffaele University, Milan, Italy., Melloni A; Unit of Vascular Surgery, IRCCS Ospedale San Raffaele, Milan, Italy., Vallesi V; Unit of Vascular Surgery, IRCCS Ospedale San Raffaele, Milan, Italy., Kahlberg A; University of Insubria, Varese, Italy 4 Vita-Salute San Raffaele University, Milan, Italy.; Unit of Vascular Surgery, IRCCS Ospedale San Raffaele, Milan, Italy., Chiesa R; Unit of Vascular Surgery, IRCCS Ospedale San Raffaele, Milan, Italy., Melissano G; Unit of Vascular Surgery, IRCCS Ospedale San Raffaele, Milan, Italy.
Jazyk:	angličtina
Zdroj:	International angiology : a journal of the International Union of Angiology [Int Angiol] 2022 Oct; Vol. 41 (5), pp. 444-453. Date of Electronic Publication: 2022 Aug 01.
DOI:	10.23736/S0392-9590.22.04884-2
Abstrakt:	Background: To face the "first wave" of the pandemic (01/03/2020-15/05/2020), Lombardy's healthcare system was reorganized according to the "Hub-and-Spoke" model, and deferrable inpatient and outpatient activities were suspended. The limitations imposed by COVID-19, associated with patients' fear of presenting to medical attention, may have led to a delay in diagnosis and treatment of time-dependent pathologies. Our multicenter retrospective cohort study aims at analyzing the impact on COVID-negative patients of the shift of medical resources in Lombardy, the Italian epicenter of the pandemic. Methods: Inclusion criteria were an age ≥18, COVID-negative condition, and referral to IRCCS Istituto Clinico Humanitas - Rozzano, Milan (Spoke Center) or IRCCS Ospedale San Raffaele - Milan (Hub Center) for acute vascular diseases requiring urgent treatment. SARS-CoV-2 infection, either on admission or during hospitalization, was the exclusion criterion. Data of the "first wave" were compared with the corresponding months of 2019, to highlight differences in vascular pathologies' case rates, clinical presentation, treatment type and post-treatment outcomes (mortality, rate of adverse events, primary and secondary clinical success and of amputation). Results: Two hundred and two patients were treated for acute vascular diseases, 52 in 2019, 150 in 2020 (P<0.001). A later presentation to medical attention (4.3 versus 5.9 days after symptoms onset, P=0.03) and an increased need for urgent treatment for peripheral arterial disease (P=0.04) differentiated 2020. A higher number of peripheral arterial disease patients underwent major amputations (P=0.38). Access to post-surgical rehabilitation programs was restricted (P<0.001). Conclusions: During the first wave of COVID-19 pandemic, in the face of a radical health care rearrangement, no increase in mortality nor in post-operative adverse event rate was registered. Anyway, urgent hospitalizations for vascular disease increased, more specifically for peripheral ischemia, in which late presentation may have influenced an increase in amputation rate.
Databáze:	MEDLINE
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