Dedicated protocol in Bologna vascular unit allowed maintenance of elective activity during emergency COVID-19 phase

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A dedicated protocol in the Bologna metropolitan vascular surgery unit in Italy allowed for the maintenance of regular elective vascular surgery activity during the emergency phase of the COVID-19 pandemic, with no contamination of patients of physicians and minimal need for intensive care (IC) resources. This was the conclusion of a study recently published in the July edition of the European Journal of Vascular and Endovascular Surgery (EJVES).

Rodolfo Pini (University of Bologna, Policlinico S Orsola, and Ospedale Maggiore, Bologna, Italy) and colleagues analysed the activity of the Bologna metropolitan vascular surgery unit from 8 March to 8 April 2020. This period covered the highest recorded rate of infections from COVID-19 in Emilia-Romagna, the region with the second highest level of documented cases of COVID-19 infections, after Lombardia. During this period, surgical activity was maintained only for acute or elective procedures obeying priority criteria.

The authors note that the preventive screening protocol consisted of nasopharyngeal swabs (NPS) for all patients and physicians with symptoms and for unprotected contact infected cases, and serological physician evaluations every 15 days. In addition, patients treated in the acute setting were considered theoretically infected and the necessary protective devices were used.

Pini and colleagues evaluated the number of patients and the possible infection of physicians and compared the number and type of interventions and the need for postoperative IC during this period with those in the same periods in 2018 and 2019.

Writing in EJVES, the authors detail that 151 interventions were performed, of which 34 (32%) were acute/emergency. The total number of interventions was similar to those performed in the same periods in 2019 and 2018: 150 (33, of which 22% acute/emergency) and 177 (29, 25% acute/emergency), respectively. IC was necessary after 6% (17% in 2019 and 20% in 2018) of elective operations and 33% (11) of acute/emergency interventions.

Furthermore, none of the patients treated electively were diagnosed with COVID-19 infection during hospitalisation. Of the 34 patients treated in acute/emergency interventions, five (15%) were diagnosed with COVID-19 infection. It was necessary to screen 14 (47%) vascular surgeons with NPS after contact with infected colleagues, but none for unprotected contact with patients; all were found to be negative on NPS and serological evaluation.

Pini et al mention some limitations of the study, including the scarce number of procedures included, its retrospective nature, and that the data are not associated with a control group to evaluate the real efficacy of the protocols adopted. They note another “element of reflection” as being the rate of false negative tests, which can lead to spread of the infection despite precautions.

The authors conclude that, while this work is observational and limited to a short time, it may help planning the activity of other units at different times of contamination and the approach taken at the Bologna metropolitan vascular surgery unit “should be considered in an emergency situation in high-risk areas”.


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