The impact of the COVID-19 pandemic on vascular surgery practice in the United States

Mouawad, Nicolas J.; Woo, Karen; Malgor, Rafael D.; Wohlauer, Max V.; Johnson, Adam P.; Cuff, Robert. F.; Coleman, Dawn M.; Coogan, Sheila M.; Sheahan, Malachi G.; Shalhub, Sherene

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has led to widespread postponement and cancelation of elective surgeries in the United States. We designed and administered a global survey to examine the impact of COVID-19 on vascular surgeons. We describe the impact of the pandemic on the practices of Vascular Surgeons in the United States. METHODS: The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons is an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Task Force disseminated April 14-24, 2020. This analysis focuses on pattern changes in vascular surgery practices in the United States including the inpatient setting, ambulatory, and vascular laboratory setting. Specific questions regarding occupational exposure to COVID-19, adequacy of personal protective equipment (PPE), elective surgical practice, changes in call schedule, and redeployment to non-vascular surgery duties were also included in the survey. Regional variation was assessed. The survey data were collected using REDCap and analyzed using descriptive statistics. RESULTS: A total of 535 vascular surgeons responded to the survey from 45 states. Most of the respondents were male (73.1%), White (70.7%), practiced in urban settings (81.7%), and in teaching hospitals (66.8%). Almost half were in hospitals with greater than 400 beds (46.4%). There was no regional variation in the presence of pre-operative COVID-19 testing, COVID-19 OR protocols, adherence to national surgical standards, and the presence of PPE. The overwhelming majority of respondents (91.7%) noted elective surgery cancellation, with the Northeast and Southeast regions having the most case cancellations 94.2% and 95.8% respectively %). The Northeast region reported the highest percentage of operations/procedures on patients with COVID-19, which was either identified at the time of the surgery or later in the hospital course (82.7%). Ambulatory visits were performed via telehealth (81.3%), with 71.1% having restricted hours. Over half of OBLs were closed, although there was regional variation with over 80% in the Midwest being closed. Cases performed in OBLs focused on critical limb ischemia (42.9%) and dialysis access maintenance (39.9%). Call schedules modifications were common, although the number of call days remained the same (45.8%). CONCLUSIONS: Vascular surgeons in the United States report substantial impact on their practices during the COVID-19 pandemic, and regional variations are demonstrated - particularly in OBL utilization, ICU bed availability, and COVID-19 exposure at work.