Implications of the severe acute respiratory syndrome associated with the novel coronavirus-2 on vascular surgery practices.

BACKGROUND: We sought to understand the effects of coronavirus disease-2019 (COVID-19) on vascular surgery practices as related to the Vascular Activity Condition (VASCON) scale. METHODS: All members of the Vascular and Endovascular Surgery Society were surveyed on the effects of COVID-19 in their practices, educational programs, and self-reported grading of their surgical acuity level using the VASCON scale. RESULTS: Total response rate was 28% (206/731). Most respondents (99.5%) reported an effect of COVID-19 on their practice, and most were VASCON3 or lower level. Most reported a decrease in clinic referrals, inpatient/emergency room consults, and case volume (P < .00001). Twelve percent of respondents have been deployed to provide critical care and 11% medical care for COVID-19 patients. More than one-quarter (28%) face decreased compensation or salary. The majority of respondents feel vascular education is affected; however, most feel graduates will finish with the necessary experiences. There were significant differences in answers in lower VASCON levels respondents, with this group demonstrating a statistically significant decreased operative volume, vascular surgery referrals, and increased hospital and procedure limitations. CONCLUSIONS: Nearly all vascular surgeons studied are affected by the COVID-19 pandemic with decreased clinical and operative volume, educational opportunities for trainees, and compensation issues. The VASCON level may be helpful in determining surgical readiness.

General outcomes and risk factors for minor and major amputations in Brazil.

Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.