The COVID-19 pandemic’s effect on the healthcare industry has been profound: Outpatient surgery volumes dropped by 71% in the first months of the pandemic. At one point, hospitals collectively were losing $1.4 billion a day.1

Another more recent analysis revealed nearly nine of 10 elective ambulatory and inpatient vascular surgeries were canceled after the United States shut down at the beginning of the pandemic.2

“When it came to outpatient surgeries, around 89% of vascular surgeons had major disruption in the outpatient clinic,” says Nicolas J. Mouawad, MD, MPH, MBA, FACS, vice chair of the department of surgery at McLaren Health System in Bay City, MI.

The Society for Vascular Surgery Wellness Task Force released an anonymous, cross-sectional survey between April 14 and April 24, 2020. Called the Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons, participants answered questions about their occupational exposure to COVID-19. adequacy of personal protective equipment (PPE), elective surgical practice, changes in call schedule, and their redeployment to non-vascular surgery duties.

The survey showed 71% of surgeons worked limited hours and more than 80% started using telehealth. “Interestingly, there was a proportion of surgeons who offered no clinic or telehealth services and stopped offering vascular surgery care altogether,” Mouawad reports.

About one-third of the 535 vascular surgeons who responded to the survey were asked to redeploy in the ICU or other places to perform non-vascular surgery tasks. One of their most common duties was placement of central venous catheters.

Nearly 18% of vascular surgeons operated on a COVID-19 patient. Most of the time, they waited outside the operating room during the intubation and used N95 respirator masks during the operation.

Most surgeons (94.8%) said they had adequate personal protective equipment. Only 6% of participants said they were self-quarantined after operating on a patient who later tested positive for COVID-19, Roughly 10% of survey respondents said they were tested for SARS-CoV-2.

Fewer than 1% of respondents said they tested positive for COVID-19, although 47.5% said they were considered at high risk for infection.

The repercussions of the suspension of elective vascular surgeries are poor outcomes in patients because of the delays. Mouawad and colleagues are looking at data for a follow-up study to see whether more patients lost their legs, suffered strokes, or died because of delayed vascular care.

As the pandemic progressed, evidence showed that COVID-19 affected many patients’ vascular systems. “We know that COVID-19 can cause coagulation, clotting of blood, and we don’t know the specific scientific reason yet, but we’re well aware of that,” Mouawad says. “People are presenting with a lot more blood clots, DDTs, and PEs.”

Mouawad directs a pulmonary embolism response team. “We have to remove the clots from their lungs because of this issue,” he says. “We’re seeing a lot of people come in with clots these days, secondary to COVID-19.”

In the pandemic’s next phase, vascular surgeons will be more aggressive about remaining available for operating on COVID-19-positive patients, according to Mouawad. Restoring confidence will take surgeons going to social media and using better communication tools.

“I’ve been very aggressive about that, personally, and while we’re all worried and scared about COVID-19, we still have to go to the doctor and get things [treated], especially circulation issues,” Mouawad says.

Surgeons are feeling safer as some elective surgeries resume and operating rooms try to return to some semblance of normal. Whatever happens, patients cannot wait forever to undergo important procedures.

“If I’m worried about a patient and am not sure whether the person is COVID-positive or not, then I’ll operate on the patient and wear full PPE,” Mouawad says.

REFERENCES

  1. Crowe. Hospital volumes hit unprecedented lows. $1.4B daily revenue losses mean long recovery ahead. May 2020.
  2. Mouawad NJ, Woo K, Malgor RD, et al. The impact of the COVID-19 pandemic on vascular surgery practice in the United States. J Vasc Surg 2020; Sep 1;S0741-5214(20)31920-0. doi: 10.1016/j.jvs.2020.08.036. [Online ahead of print].