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(N=121)Southeast (N=118)Midwest (N=115)West/Southwest (N=19)Fig 2.The regional distribution of continued elective vascular surgical cases as reported by 41 respondents. Northeast (N=121)Southeast (N=118)Midwest (N=114)West/Southwest (N=139)Fig 3.The regional distribution of duties to which vascular surgeons were redeployed. These included managing patients in the intensive care unit (ICU), taking shifts to assist the ICU teams in placing lines (lines), seeing patients in the emergency department (ED), covering other surgery services (other surgery), administrative tasks (administrative), and additional educational/research responsibilities (education/research).Journal of Vascular Surgery Mouawad et al 777Volume 73, Number 3 at that time and thus limited the detail surrounding cancelled“elective”cases. This language will be included in future survey design. The survey evaluated the impact of COVID-19 on vascular surgeons practicing in the United States at a single point in time. Our data show that vascular surgical care and surveillance has been restricted,and will likely continue to be limited as the COVID-19 pandemic continues. The long-term effects onvascular patients are unknown, and the greater needfor preserving public health resources to the popula-tion remains a priority. The unknown sequelae ofunanticipated delays on vascular surgical care and pa-tient outcomes prompted the creation of the VascularSurgery COVID-19 Collaborative to prospectively followthese impacts.18CONCLUSIONSThe COVID-19 pandemic led to dramatic changes to the delivery of vascular surgical care in the United Statesduring the period of April 14 to 24, 2020 and regional var-iations in practice patterns were identified. Theseincluded significant cancellations of elective surgicalcases, reduction in outpatient visits, and lower use ofthe vascular lab. Vascular care was continued via tele-medicine and for cases favoring life over limb.AUTHOR CONTRIBUTIONSConception and design: NM, RF, MW, AJ, SSAnalysis and interpretation: NM, KW, RM, SC, SSData collection: SSWriting the article: NM, KW, RF, MW, RC, MS, SSCritical revision of the article: NM, KW, RF, MW, AJ, RC, DC,SC, MS, SSFinal approval of the article: NM, KW, RF, MW, AJ, RC, DC,SC, MS, SSStatistical analysis: SSObtained funding: Not applicableOverall responsibility: SSREFERENCES1.COVIDSurg Collaborative. Elective surgery cancellations dueto the COVID-19 pandemic: global predictive modelling toinform surgical recovery plans. Br J Surg 2020 May 12. [Epubahead of print].2. American College of Surgeons. COVID-19: Recommenda-tions for Management of Elective Surgical Procedures.Table III.Coronavirus disease-19 (COVID-19) related changes in outpatient and diagnostic vascular laboratory 2021 Most nations with developed healthcare systems have a strong interest in audit, both for financial and clinical quality control. Whereas financial control has been a key political requirement for managing healthcare, the use of clinical outcome data has, until recently, taken more of a back seat. Clinical audit has a long history of describing outcomes and challenging established attitudes or practice.1 Responses to published audits vary. Some clinicians voice criticism of bias as a result of selective reporting, either from a few units, or because of incomplete datasets. 2 Attitudes have gradually changed with improved understanding of the role of audit as a tool to examine and refine standards of practice. 3 This has been accompanied by a growth in clinical audit across all branches of medicine. The turn of the century marked a shift towards more widespread clinical audit, with development of political interest in using quality to justify or contain costs. The advent of organisations such as the National Institute for Clinical Excellence (NICE) in the UK saw a growth in the use of research and audit to set standards both for outcomes and processes of care. A good example of this in vascular surgery is the NICE clinical guideline 68, which sets out clear standards for assessment, referral, and treatment of patients with TIA and minor stroke. 4 These standards are incorporated into national audits in Europe and reporting now
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