Caseload and In-Hospital Outcome of Carotid Surgery Performed during the COVID-19 Pandemic vs. Previous Years: A Single-Centre Analysis

Abstract

Introduction

With the beginning of the COVID-19 pandemic in March 2020, restrictions and challenges for elective and emergency vascular surgery as well as worse outcomes were reported. This study aims to compare our single-centre experience with carotid artery surgery during the pandemic and previous years.

Methods

Our retrospective analysis included all consecutive patients undergoing carotid surgery for symptomatic and asymptomatic stenosis between January 2017 and December 2021. Caseload, operation specific parameters, and demographic data as well as in-hospital outcome were compared during the COVID-19 pandemic versus previous years.

Results

A total of 623 consecutive patients were included. The caseload comparison showed an average of 112 carotid artery surgeries per adjusted year (March 16th to December 31st) from 2017 to 2019, prior to the pandemic. The caseload reduction in the first year of the pandemic (2020) was 36.6% (n = 71) and 17.9% (n = 92) in the second year (2021). No rebound effect was observed. There was no significant difference (p = 0.42) in the allocation of symptomatic and asymptomatic patients (asymptomatic patients: 37.1% prior vs. 40.8% during the pandemic; symptomatic patients: 62.9 vs. 59.2%). Major adverse event rates in years prior to the pandemic were postoperative bleeding requiring revision: n = 31 (7.1%); stroke in symptomatic patients: n = 9 (3.3%) and stroke in asymptomatic patients: n = 4 (2.5%); symptomatic myocardial infarction (MCI): n = 1 (0.2%); death: n = 2 (0.5%). During the pandemic, major adverse event rates were postoperative bleeding requiring revision: n = 12 (6.5%); stroke in symptomatic patients: n = 1 (0.9%), stroke in asymptomatic patients: n = 1 (1.3%); symptomatic MCI: n = 1 (0.5%); death: n = 1 (0.5%).

Conclusion

Since the beginning of the COVID-19 pandemic in March 2020, there has been a significant reduction in carotid artery surgery performed both in symptomatic as well as in asymptomatic patients. There was no worsening of the outcome of carotid surgery performed during the COVID-19 pandemic, and this remained safe and feasible.

Zusammenfassung

Einführung

Mit Beginn der COVID-19-Pandemie im März 2020 wurden Einschränkungen und Herausforderungen für elektive und notfallmäßige Gefäßoperationen sowie eine Verschlechterung der Ergebnisse gemeldet. Diese Studie zielt darauf ab, unsere Single-Center-Erfahrungen während der Pandemie und in früheren Jahren zu vergleichen.

Material und Methoden

Unsere retrospektive Analyse umfasste alle Patient*innen, die sich zwischen Januar 2017 und Dezember 2021 einer Karotisoperation wegen symptomatischer und asymptomatischer Stenose unterzogen. Die Fallzahl, operationsspezifische Parameter und demografische Daten sowie das Ergebnis im Krankenhaus wurden während der COVID-19-Pandemie mit den Vorjahren verglichen.

Ergebnisse

Insgesamt wurden 623 Patient*innen eingeschlossen. Der Fallzahlenvergleich ergab einen Durchschnitt von 112 Halsschlagaderoperationen pro angepasstem Jahr (16. März bis 31. Dezember) von 2017 bis 2019 vor der Pandemie. Die Fallzahlreduktion betrug im 1. Jahr der Pandemie (2020) 36,6% (n = 71) und im 2. Jahr (2021) 17,9% (n = 92). Es wurde kein Rebound-Effekt beobachtet. Es gab keinen signifikanten Unterschied (p = 0,42) bei der Verteilung von symptomatischen und asymptomatischen Patient*innen (asymptomatische Patient*innen: 37,1% vor vs. 40,8% während der Pandemie; symptomatische Patient*innen: 62,9% vs. 59,2%). Die Raten schwerwiegender unerwünschter Komplikationen in den Jahren vor der Pandemie waren: postoperative Blutungen, die eine Revision erforderten: n = 31 (7,1%); Schlaganfall bei symptomatischen Patienten: n = 9 (3,3%) und Schlaganfall bei asymptomatischen Patienten: n = 4 (2,5%); symptomatischer Myokardinfarkt (MCI): n = 1 (0,2%); Tod: n = 2 (0,5%). Während der Pandemie kam es zu folgenden schwerwiegenden unerwünschten Komplikationen: postoperative Blutungen, die eine Revision erforderten: n = 12 (6,5%); Schlaganfall bei symptomatischen Patient*innen: n = 1 (0,9%), Schlaganfall bei asymptomatischen Patient*innen: n = 1 (1,3%); symptomatischer MCI: n = 1 (0,5%); Tod: n = 1 (0,5%).

Schlussfolgerung

Seit Beginn der COVID-19-Pandemie im März 2020 kam es zu einem deutlichen Rückgang der durchgeführten Halsschlagaderoperationen, sowohl bei symptomatischen als auch bei asymptomatischen Patient*innen. In unserem Zentrum kam es zu keiner Verschlechterung der Ergebnisse während der COVID-19-Pandemie durchgeführten Karotisoperationen und verblieben somit sicher durchführbar.

Keywords

stenosis of the carotid artery - case load - endarteriectomy - COVID

Schlüsselwörter

Karotisstenose - Karotisdesobliteration - OP-Frequenz - Case Load - COVID

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