Reflection of the Impact of COVID-19 Infection on Vascular Surgery Outcomes: A Multicenter Analysis of Peripheral Vascular Interventions and Infrainguinal Bypass.

Overview

abstract

BACKGROUND: The impact of COVID-19 on vascular surgery patients remains incompletely understood. Emerging evidence suggests that individuals with vascular disease are at increased risk for complications. This study aimed to describe postoperative outcomes and one-year survival in COVID-19 patients undergoing vascular procedures using a multicenter real-world dataset. METHODS: We retrospectively reviewed patients undergoing peripheral vascular interventions (PVI) and infrainguinal bypass procedures in the Vascular Quality Initiative (2020-2022). Multivariable logistic regression assessed in-hospital adverse events; Kaplan-Meier and Cox regression analyses assessed one-year survival. RESULTS: Among 16,608 PVI patients and 10,460 infrainguinal bypass patients urgent/emergent procedures were more common in COVID-19 patients (PVI: 50.9%; bypass: 40%). COVID-19 patients undergoing PVI had higher in-hospital mortality (10.9% vs 1.8%, OR: 4.9, 95% CI: 3.2-7.9), ipsilateral amputation (17.7% vs 10.6%, OR: 1.8, 95% CI: 1.2-2.5), renal complications (4.1% vs 1.8%, OR: 1.9, 95% CI: 1.1-3.5), and pulmonary complications (6.8% vs 1.2%, OR: 4.9, 95% CI: 3.0-7.9) compared with non-COVID patients. COVID-19 infrainguinal bypass patients had higher rates of ipsilateral amputation (OR: 1.6, 95%CI (1.0-2.6), P=0.049). One-year mortality was higher in COVID-19 PVI patients (HR: 2.1, 95% CI: 1.5-2.9). There was no significant difference in bypass patients. CONCLUSIONS: COVID-19 patients undergoing PVI faced significantly increased risks of renal and pulmonary complications, limb loss, and mortality. Those undergoing infrainguinal bypass also had higher limb loss risk. Surgeons should ensure optimal medical optimization, close monitoring, and consider deferring elective procedures to minimize morbidity and mortality.