Adapting vascular surgery practice to the current COVID-19 era at a tertiary academic center in Madrid.

Valdivia, Andrés Reyes; Sanus, Enrique Aracil; Santos, África Duque; Olmos, Cristina Gómez; Alguacil, Sergio Gordillo; El Amrani, Mehdi; Guaita, Julia Ocaña; Zúñiga, Claudio Gandarias

INTRODUCTION: The epidemic potential of Coronavirus infection is now a reality. Since the first case detected in late 2019 in China a fast-world-wide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease due to its nature associating several comorbid states and thus, some Vascular Surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times. METHODS: Observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spain; one of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14(th) when the lockdown was declared up to date, May 14(th) (2 months). Procedural surgical practice, organizational issues, early outcomes and all the troubles encountered during this new situation are described. RESULTS: Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the time period. Five surgeries were performed on 3 COVID-19 positive patients. Sixty percent were due to CLI, 45% of them performed by complete endovascular approach; whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff. CONCLUSIONS: The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semi-urgent surgical care alone. The lack for in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision making in some cases.