The global impact of COVID-19 on vascular surgical services

The global spread of the 2019 novel coronavirus (COVID-19) has profoundly affected the way we conduct our health care practices. As of March 19, 2020, Singapore has had 330 confirmed cases of COVID-19 infection.¹ Singapore detected the first case of COVID-19 on January 23, 2020, and had the highest number of COVID-19 cases outside of mainland China from February 7, 2020, to February 20, 2020.² Since the start of February 2020, we have instituted significant changes to our routine vascular surgical service. We adopted a split-team policy and encouraged complete team segregation to reduce the risk of intradepartmental cross-contamination. We conducted phone interviews with outpatients to determine whether their appointment can be postponed, reducing their need to visit the hospital. Last, we rescheduled elective cases and performed only emergency surgery to preserve hospital resources such as intensive care unit beds.

To understand more about the global impact of COVID-19 on vascular surgical services, we designed a questionnaire that addressed four pertinent themes including outpatient services, inpatient care, elective surgery, and emergency surgery. The questionnaire consisted of seven multiple choice questions and three open-ended questions (Appendix, online only). The questionnaire was targeted at vascular surgeons and was distributed online in vascular surgery interest groups using various social media platforms. The questionnaire was open from March 16 to March 20, 2020, and did not collect any identifiable data. Valid responses were represented as categorical data and presented in percentages.

A total of 77 individual responses were obtained. Of these, 29 (37.7%) were from the European Union, 12 (15.6%) were from Southeast Asia, 10 (13.0%) were from the United Kingdom, 10 (13.0%) were from the Middle East, 7 (9.1%) were from the United States of America, and 9 (11.7%) were from other countries. Of the 77 respondents, 45 (58.4%) were working in a split-team fashion. When asked about outpatient services, 69 (89.6%) replied that outpatient services were either suspended or scaled down. When asked about inpatient services, 61 (79.2%) replied that inpatient services were either suspended or scaled down. With regard to elective vascular surgical cases, 70 (90.9%) replied that at least some if not all elective cases were cancelled. The majority of cases cancelled were varicose vein surgery, revascularization for claudication, “small” or asymptomatic aortic aneurysms, dialysis access work, and asymptomatic carotid stenoses. On the contrary, 71 of 77 respondents (92.2%) are still performing all emergency vascular surgery (Fig ). For a large majority of respondents (67/77 [87.0%]), face-to-face multidisciplinary or team meetings have been reduced or cancelled entirely and have been replaced by online messaging platforms, video conferencing, teleconferencing, or e-mail discussions.

Fig.

Bar chart showing the state of health care practices during COVID-19.

The impact of COVID-19 on vascular surgical services has been far-reaching. The majority of respondents have reported a reduction in or cessation of outpatient services and elective cases while continuing emergency surgery. This is in accordance with the recommendations provided by the American College of Surgeons.³ At the same time, we must also start making preparations to handle the backlog of cases once COVID-19 recedes.

Appendix (online only).

Questionnaire

• 1.What is your country of practice?
• 2.
  Is a split-team or team segregation policy implemented in your vascular surgical service?

  • a.
    Yes
  • b.
    No
  • c.
    Other (please specify)
• 3.
  How has COVID-19 affected your outpatient vascular surgical service?

  • a.
    Outpatient services completely cancelled
  • b.
    Outpatient services scaled down (ie, nonurgent patients postponed/cancelled)
  • c.
    Outpatient services operate as per usual
  • d.
    Other (please specify)
• 4.
  How has COVID-19 affected your inpatient vascular surgical service?

  • a.
    Inpatient services completely cancelled
  • b.
    Inpatient services scaled down (ie, reduction in allocated bed numbers)
  • c.
    Inpatient services operate as per usual
  • d.
    Other (please specify)
• 5.
  How has COVID-19 affected your elective surgical service?

  • a.
    All elective cases are cancelled
  • b.
    Some elective cases are cancelled
  • c.
    No elective cases are cancelled
  • d.
    Other (please specify)
• 6.If elective surgical cases have been cancelled, what type of cases are they? Leave blank if no elective surgical cases have been cancelled.
• 7.
  How has COVID-19 affected your emergency surgical service?

  • a.
    All emergency cases are rejected
  • b.
    Only some emergency cases are rejected
  • c.
    No emergency cases are rejected
  • d.
    Other (please specify)
• 8.If emergency surgical cases have been rejected, what type of cases are they? Leave blank if no emergency surgical cases have been rejected.
• 9.
  How has COVID-19 affected face-to-face multidisciplinary meetings?

  • a.
    All face-to-face multidisciplinary meetings are cancelled
  • b.
    Some face-to-face multidisciplinary meetings are cancelled
  • c.
    No face-to-face multidisciplinary meetings are cancelled
  • d.
    Other (please specify)
• 10.
  What modality has replaced face-to-face multidisciplinary meetings? Leave blank if your face-to-face multidisciplinary meetings have not been cancelled. (You can choose more than one option.)

  • a.
    Teleconference
  • b.
    Video conference
  • c.
    Online messaging platforms (eg, WhatsApp, Telegram)
  • d.
    E-mail
  • e.
    Other (please specify)