Embedded Files
pandemic, such asthe Northeast region. On-call schedules were modifiedin terms of call distribution and frequency to promotephysical distancing and minimize the exposure of multi-ple members of the team at a given time.Contemporary vascular surgical practice has promotedoutpatient management and encouraged the use ofOBLs to offload the demands of larger hospital facilities.Despite their multiple benefits, changes in outpatientservices were expected during this crisis, and many ofthe vascular practices limited their OBL hours; reasonsincluded helping to promote physical distancing, mini-mizing provider exposure, unavailability of staff (owingtofinancial restrictions and/or furlough at large healthsystems), and, most commonly, patients’fear of contract-ing COVID-19 in a health care facility. Most practices con-verted to offering consults via telephone ortelemedicine/telehealth visits. The lack of in-personmeetings has essentially become commonplace and tel-ehealth is becoming a“must-have”for practice viability.Interestingly, 15 respondents noted that their officesclosed and they offered no telehealth capabilities; thisfinding was not regionally specific. Significant regionalvariation was identified, with more than 80% of OBLs inthe Midwest closing as compared with only 31.5% and35.1% in the Southeast and West/Southwest, respectively.Chronic limb-threatening ischemia and dialysis mainte-nance were the types of cases most frequently being per-formed in the OBL setting.The majority of respondents noted a shift toward thevascular diagnostic laboratory performing only urgentoutpatient referrals and inpatient consults at their insti-tutions. Mitigation options revolved around decreasingthe frequency of the vascular laboratory evaluations orTable II.Coronavirus disease-19 (COVID-19) occupational exposure and related changes to in-hospital surgical practiceVariablesAllRegionPvalueNortheast Southeast Midwest West/SouthwestICU availability College of Surgeons/Society for Vascular Surgery; ED, emergency department;ICU, intensive care unit;OR, operating room;PACU,postanesthesia care unit;PPE, personal protective equipment.Values are number (%).776Mouawad et alJournalofVascularSurgeryMarch 2021 11-15decreasing hours of service. Clearly, delaying vascularpathology surveillance made many uncomfortable andoptions to maintain such schedules were explored. Ur-gent outpatient studies were still being performed without regional variation, although the Midwest continued to do a large proportion of inpatient evaluations.Several limitations exist owing to the self-reported sur-vey design, which can introduce social desirability bias,recall bias, and respondent selection bias. This survey isa snapshot of 10 days during a very dynamic situation of early COVID-19 experience, with circumstances chang-ing daily. Some of the states were on the steep part ofthe pandemic curve and getting ready to peak, whereasothers did not see large influx of infected patients at thetime of survey completion. In particular, a significant number of respondents to the survey were from theNew York, Michigan, and California, all of whom were severely affected by the pandemic during this period.The majority of the respondents were from urban andteaching hospitals; thus, the responses reflect mostlythis experience. The majority of the respondents werefrom urban and teaching hospitals thus the responsesreflect mostly this experience. Also, surgeons may have appointments in more than one facility, such as joint ap-pointments with the Veteran’s Administration (VA).These surgeons may have selected their primary hospital rather than the VA; therefore, the VA may be under represented. Last, the timing of the survey development anddissemination coincided with the rapid development of practice guidelines and the common language we arenow all familiar with such as the Vascular Activity Condi-tion or VASCCON language or the tiers 1 to 3 by theACS.3,6These were not incorporated in the survey designAny elecvecasesAorcCarodDialysis access Lower extremity revascularizaon Venous Northeast
Report abuse