COVID-19 pandemic spurred steep reduction in vascular procedures
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Key takeaways:
- The rate of vascular procedures in Brazil dropped significantly during the pandemic.
- There was also an increase in lower-limb amputations and vena cava filter placements.
Data show that the COVID-19 pandemic and resulting reorganization of health systems led to a significant reduction in vascular procedures in 2020 and 2021 across Brazil, leading to a $17 million reduction in spending on vascular surgeries.
In an analysis, researchers also observed a significant increase in the number of lower-limb amputations and vena cava filter placements during the same period.
Image: Adobe Stock
“More recently, efforts have been focused on assessing the direct impacts of the pandemic on surgical indications, the number of surgical procedures, and the types of procedures (elective vs. urgent) in various surgical specialties,” Marcelo Fiorelli Alexandrino da Silva, MD, a vascular surgeon at Hospital Israelita Albert Einstein in Sao Paulo, and colleagues wrote in the study background. “Most institutions had their elective procedures suspended as most health care resources were redirected to care patients with COVID-19. ... As a result of the pandemic, over a million surgical procedures have been delayed or canceled in Brazil. In this context, surgical treatments in all specialties were affected, including those of vascular diseases.”
In a cross-sectional study, Alexandrino da Silva and colleagues analyzed data from 521,069 vascular surgical procedures performed in Brazilian public hospitals and outpatient clinics 2 years before the pandemic (2018-2019) and 2 years during the pandemic (2020-2021), using data from the Unified Health System. Researchers also assessed public reimbursement per procedure, with financial data converted to U.S. dollars according to the average dollar exchange rate during the study period.
The findings were published in the Annals of Vascular Surgery.
Compared with 2018-2019, researchers observed a decrease in elective (P = .001) and emergency (P = .005) open abdominal aortic aneurysm repairs, elective endovascular AAA repairs (P < .001), elective thoracic aortic aneurysm repairs (P = .007), elective open peripheral aneurysm repairs (P = .038), carotid endarterectomies (P < .001) and angioplasties (P = .001), open revascularizations for PAD (P < .001), surgical treatment for chronic venous disease (P < .001) and sympathectomies for hyperhidrosis (P < .001). Concurrently, researchers observed increases in the number of lower-limb amputations (P = .027) and vena cava filter placements (P = .005).
“Overall, there was a reduction of almost $17 million in spending on vascular surgeries during the pandemic years, corresponding to a decrease of more than 15% expenditures compared to the pre-pandemic period,” the researchers wrote.
The researchers noted that the largest reductions — more than 60% — were observed for surgical treatments of chronic venous disease and hyperhidrosis. There was also a 12.17% increase in hospital admission of patients with acute limb ischemia during the pandemic period, which the researchers said may explain the increased amputation rates. Researchers also observed an increase in mortality for open emergency surgeries for AAAs and elective treatment of thoracoabdominal aneurysms.
“This increase cannot be explained solely by coinfection with COVID during surgeries,” the researchers wrote. “Probably changes in the infrastructure or organization of the care teams also have an influence on these findings, as well as a delay in care-seeking by patients.
“It is essential to know this epidemiology to predict upcoming challenges and demands in vascular care to better allocate resources and prevent future excess deaths and excess lost workdays or lost manpower due to delated aortic repair, carotid revascularization, limb revascularization or varicose vein surgeries,” the researchers wrote.
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