• Andrea Kahlberg, Daniele Mascia, Raffaello Bellosta, Luca Attisani, Matteo Pegorer, Anna M Socrate, Matteo Ferraris, Piero Trabattoni, Enrico Rinaldi, Andrea Melloni, Fabrizio Monaco, Germano Melissano, and Roberto Chiesa.
• Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: kahlberg.andrea@hsr.it.
• Eur J Vasc Endovasc Surg. 2021 Feb 1; 61 (2): 306-315.

ObjectiveDuring the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing.MethodsData from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs.ResultsAmong 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs.ConclusionDuring the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events.Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

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