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.

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.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Kidney Injury / etiology
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Andorra / epidemiology
  • COVID-19 / complications*
  • COVID-19 / mortality
  • Cohort Studies
  • Female
  • Humans
  • L-Lactate Dehydrogenase / blood
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Prognosis
  • Respiratory Distress Syndrome / etiology
  • Risk Factors
  • Spain / epidemiology
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects*

Substances

  • L-Lactate Dehydrogenase

Associated data

  • ClinicalTrials.gov/NCT04333693