OUTCOMES AFTER VASCULAR SURGERY PROCEDURES IN PATIENTS WITH COVID-19 INFECTION: A NATIONAL MULTICENTRE COHORT STUDY (COVID-VAS)

San Norberto, EM; De Haro, J; Peña, R; Riera, L; Fernández-Caballero, D; Sesma, A; Rodríguez-Cabeza, P; Ballesteros, M; Gómez-Jabalera, E; Taneva, GT; Aparicio, C; Moradillo, N; Soguero, I; Badrenas, AM; Lara, R; Torres, A; Sala, VA; Vaquero, C

OBJECTIVES: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS: This is a multicentre, 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 endpoint 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. 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 (x10(9)/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 (x10(9)/L) (p=0.019) leucocytes>11.5 (x10(9)/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 (x10(9)/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.