Impact of the COVID-19 Pandemic on Complex Aortic Aneurysm Surgery

Mickael Palmier; Côme Bosse; Petroula Nana; Thomas Le Houérou; Mark Tyrrell; Julien Guihaire; Dominique Fabre; Stéphan Haulon

doi:10.1177/15266028231210214

Impact of the COVID-19 Pandemic on Complex Aortic Aneurysm Surgery

J Endovasc Ther. 2023 Nov 19:15266028231210214. doi: 10.1177/15266028231210214. Online ahead of print.

Authors

Mickael Palmier^{1

2}, Côme Bosse¹, Petroula Nana¹, Thomas Le Houérou¹, Mark Tyrrell³, Julien Guihaire¹, Dominique Fabre¹, Stéphan Haulon¹

Affiliations

¹ Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France.
² Vascular Surgery Department, CHU Rouen, Rouen, France.
³ Cleveland Clinic London and King's Health Partners, London, UK.

PMID: 37981580
DOI: 10.1177/15266028231210214

Abstract

Introduction: This study aimed to evaluate the impact of COVID on total case load and peri-operative outcomes in patients undergoing open surgical repair (OSR) and endovascular repair (ER) of complex aortic aneurysms (cAAs).

Methods: A single-center retrospective analysis of prospective data of patients managed with elective cAA ER or OSR from January 2018 to December 2021 was conducted. A comparative analysis on the impact of the COVID-19 pandemic on the case volume and on the 30-day outcomes was assessed using time periods, before (2018-2019) and during the pandemic (2020-2021).

Results: During the 4-year study period, 255 patients with cAA were managed with ER and 576 with OSR. The pandemic did not reduce the cAA ER volume (p=0.12), but a statistically significant reduction in OSR case load was recorded (p=0.04). Following OSR, hospital length of stay (11.1 vs 10.3 days), and early mortality (6.94% vs 4.63%), were similar before and during the pandemic. In the ER cohort, baseline characteristics, early mortality (3.6% vs 4.1%, p=0.976), and morbidity (10% vs 14%, p=0.44), were comparable during the 2 periods. For ER cases, the hospital and intensive care unit (ICU) stay both decreased significantly (8±8-6±7 days, p<0.001 and 2±4 vs 1±6 days p=0.01, respectively) during the pandemic.

Conclusion: Resource pressures drove modifications in clinical practice to reduce the length of hospitalization, without compromising the clinical outcomes, in patients undergoing ER of cAA. This modification was not effective in patients undergoing OSR that resulted in a significant decrease of this activity.

Clinical impact: The pandemic did not reduce complex endovascular repair (ER) volume (p=0.12) while a significant reduction in open surgical repair (OSR) case load was recorded (p=0.04). For the endovascular cohort, early mortality (p=0.976) and morbidity (p=0.44) remained stable, while the hospital and intensive care unit (ICU) stay decreased (p<0.001 and p=0.01, respectively) during the pandemic.

Keywords: COVID-19; F/BEVAR; aortic aneurysm; endovascular repair; outcomes.

Publication types

Editorial