To analyse the clinical and economic impact of Coronavirus Disease (COVID) Emergency State (Cov-ES) in the Department of Vascular Surgery at a Tertiary University ‘Hub’ Hospital.
Differences in clinical practice according to Diagnostic Related Group (DRG) and International Statistical Classification of Diseases (ICD) and related Health Problems and the financial impact of Cov-ES were considered. Vascular procedures performed between March 2019 to December 2019 (Pre-pandemic) were compared to those performed in the period March 2020 – December 2020 (Pandemic). Pre-pandemic and Pandemic reimbursements of all vascular activities and the top three vascular diagnoses were evaluated.
Pre-pandemic vs Pandemic era documented a decrease of vascular consultations performed (2,882 vs 2,270, -21.2%). The number of total vascular procedures decreased from 997 to 797 (-20.1%) with a higher reduction observed in outpatient surgical activities (247 to 136, -45.0%, p=.0005) rather than inpatient surgical activities (750 vs 661, -11.9%, p=.02). Length of hospital stay (LOS) increased from 3.3± 2.7 days in Pre-pandemic to 5.3 ± 3.9 in the Pandemic era (p=.004). Among patients with limb-threatening ischemia, the rate of major limb amputation was higher in the Pandemic (3.3% vs 5.4% respectively, p=.02) and a higher rate of elective hospitalization procedures were performed as urgent/emerging setting after clinical deterioration (2.8 % vs 6.4%, p=.0002). According to DRG classification, an increase of ‘complicated’ limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) was observed pre-pandemic to pandemic (+84.2% and +25.0%, respectively). Total reimbursement for vascular activities between Pandemic vs Pre-pandemic was 4,646,108 € vs 5,054,398 €, respectively (-8.0%). Management of ‘complicated’ limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) required a higher clinical and financial support that was translated into higher economical reimbursement during the pandemic (273,035€ vs 150,005€, +82.0% and 749,250€ vs 603,680€, +24.1%, respectively).
During the Pandemic, the main resources were employed for treatment of limb-threatening ischemia, aortic aneurysm, and carotid stenosis. Inpatient activities documented an increase of major limb amputation and LOS. An increased reimbursement for each vascular procedure and for all ‘complicated’ diagnoses revealed the more serious and resource-demanding pathology occurred in this period.

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