Endovascular Aortic Repair for Ruptured Abdominal Aortic Aneurysm during the COVID-19 Era

Objective The COVID-19 pandemic caused significant stress on healthcare systems leading to altered care processes (i.e. – altered treatment algorithms, supply shortages, as well as personnel shortages). However, the effect of COVID and subsequent altered care processes on many surgical outcomes has not been characterized. In particular, patient outcomes after endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) have not been well reported. Using COVID prevalence as a surrogate for altered processes of care, our aim is to determine changes in COVID-negative patient outcomes following EVAR for rAAA. Methods Using the Center for Disease Control COVID-19 data, COVID mortality per three-month quarter was calculated in Florida. The quarters with the three highest mortality rates and three lowest mortality rates were used to establish COVID-heavy (CH) and COVID-light (CL) timeframes, respectively. Three quarters of 2019 were used for the pre-COVID (PC) timeframe for comparison. The Florida AHCA database was queried using ICD-10 codes to identify patients diagnosed with rAAA who underwent EVAR during each timeframe. COVID-positive patients were excluded. Primary outcomes were in-hospital mortality, morbidity, and length of stay (LOS). Stepwise linear and logistic regression with 10-fold cross-validation determined which factors most impacted primary outcomes. Secondary outcomes included individual complication rates. Results There were 316 patients included. There were no significant differences in surgical volume, demographics, or comorbidities except that more patients had peripheral vascular disease in CL compared to PC (p=0.01). Mortality, LOS, and complications were not significantly different per timeframe on univariable analysis. Regression confirmed that timeframe was not significantly associated with any primary outcome. Conclusion Despite increased stress on the healthcare system during the COVID-19 pandemic, outcomes following EVAR for rAAA were unchanged in Florida. These results imply that despite periods of COVID-heavy stress on the healthcare system, patient care was maintained at the pre-COVID standard of care.