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Obidike P, Chang A, Calisi O, Lee JJ, Ssentongo P, Ssentongo AE, Oh JS. COVID-19 and Mortality in the Global Surgical Population: A Systematic Review and Meta-Analysis. J Surg Res 2024; 297:88-100. [PMID: 38460454 DOI: 10.1016/j.jss.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION To date, no systematic review or meta-analysis has comprehensively estimated the risk of mortality by surgery type on an international scale. We aim to delineate the risk of mortality in patients with COVID-19 who undergo surgery. METHODS PubMed (MEDLINE), Scopus, OVID, the World Health Organization Global Literature on Coronavirus Disease, and Corona-Central databases were searched from December 2019 through January 2022. Studies providing data on mortality in patients undergoing surgery were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for abstracting data were followed and performed independently by two reviewers. The main outcome was mortality in patients with COVID-19. RESULTS Of a total of 4023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 y; 57% were male. Surgery types included general (14.9%), orthopedic (23.4%), vascular (6.4%), thoracic (10.6%), and urologic (8.5%). Patients undergoing surgery with COVID-19 elicited a nine-fold increased risk of mortality (relative risk [RR] 8.99, 95% confidence interval [CI] 4.96-16.32) over those without COVID-19. In low-income and middle-income countries (RR: 16.04, 95% CI: 4.59-56.12), the mortality risk was twice as high compared to high-income countries (RR: 7.50, 95% CI: 4.30-13.09). CONCLUSIONS Mortality risk in surgical patients with COVID-19 compared to those without is increased almost 10-fold. The risk was highest in low-income and middle-income countries compared to high-income countries, suggesting a disproportionate effect of the pandemic on resource-constrained regions.
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Affiliation(s)
- Prisca Obidike
- Department of General Surgery, University of Virginia, Charlottesville, Virginia; Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Allison Chang
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Olivia Calisi
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jungeun J Lee
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John S Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Singhal R, Dickerson L, Sakran N, Pouwels S, Chiappetta S, Weiner S, Purkayastha S, Madhok B, Mahawar K. Safe Surgery During the COVID-19 Pandemic. Curr Obes Rep 2022; 11:203-214. [PMID: 34709586 PMCID: PMC8552630 DOI: 10.1007/s13679-021-00458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. RECENT FINDINGS Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.
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Affiliation(s)
- Rishi Singhal
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Luke Dickerson
- Department of General Surgery, Leighton Hospital, Crewe, UK
| | - Nasser Sakran
- Director Bariatric Centre, Department of Surgery, Emek Medical Centre, Afula, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Sonja Chiappetta
- Head Obesity and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Sylvia Weiner
- Department of Obesity and Metabolic Surgery, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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Geldmaker LE, Hasse CH, Baird BA, Haehn DA, Anyane-Yeboah AN, Wieczorek MA, Ball CT, Dora CD, Lyon TD, Thiel DD. Impact of SARS-CoV-2 (COVID-19) on Fixed Operating Room Times in Urologic Surgeries. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 6:373-380. [PMID: 35765690 PMCID: PMC9222149 DOI: 10.1016/j.mayocpiqo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, on operating room (OR) efficiency for urologic procedures using the concept of fixed OR times. Patients and Methods Over a 24-month period, urology OR data were prospectively collected. Operations were divided into fixed and variable time points. The fixed OR times were in-roomw to anesthesia-release time, anesthesia-release to cut time, in-room to cut time, and close to wheels-out time. Data from January 1, 2019, to December 31, 2019, were pre-COVID-19 data, and data from April 1, 2020, to December 31, 2020, were post-COVID-19 data. Operations were grouped into endoscopic, implant, major open, and robotic-assisted cases. In the post-COVID-19 era, all patients had a negative polymerase chain reaction test result within 48 hours of operation. The Wilcoxon rank sum test was used to compare the fixed OR times between the pre- and post-COVID-19 eras. Results A total of 3189 procedures were evaluated: 2058 endoscopic operations (1124 in the pre-COVID-19 era and 934 in the post-COVID-19 era), 343 implant procedures (192 in the pre-COVID-19 era and 151 in the post-COVID-19 era), 222 major open procedures (119 in the pre-COVID-19 era and 103 in the post-COVID-19 era), and 566 robotic-assisted procedures (338 in the pre-COVID-19 era and 228 in the post-COVID-19 era). There were no fixed OR times in any of the examined groups that were negatively impacted by COVID-19. The percentage of the total OR time occupied by fixed OR variables in the pre-COVID-19 era was 40.6% for endoscopic operations, 41.1% for implant procedures, 29.8% for major open procedures, and 21.8% for robotic-assisted procedures. Conclusion A substantial portion of the total OR time includes fixed time points. Furthermore, COVID-19 did not have a negative impact on fixed OR times in a negative testing environment. Urologic OR efficiency should be maintained in the post-COVID-19 era.
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Affiliation(s)
| | | | - Bryce A Baird
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mikolaj A Wieczorek
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | | | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Lessons learned after one year of COVID-19 from a urologist and radiotherapist view: A German survey on prostate cancer diagnosis and treatment. PLoS One 2022; 17:e0269827. [PMID: 35700180 PMCID: PMC9197019 DOI: 10.1371/journal.pone.0269827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines.
Materials and methods
To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses.
Results
A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate.
Conclusion
While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.
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Monroy‐Iglesias MJ, Rai S, Mistretta FA, Roberts G, Dickinson H, Russell B, Moss C, De Berardinis R, Ferro M, Musi G, Brown C, Nair R, Thurairaja R, Fernando A, Cathcart P, Khan A, Dasgupta P, Malde S, Hadijpavlou M, Dolly S, Haire K, Tagliabue M, Cobelli O, Challacombe B, Van Hemelrijck M. Impact of the COVID‐19 pandemic on urological cancers: The surgical experience of two cancer hubs in London and Milan. BJUI COMPASS 2022; 3:277-286. [PMID: 35783588 PMCID: PMC9231679 DOI: 10.1002/bco2.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/01/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023] Open
Abstract
Objective Materials and Methods Results Conclusion
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Affiliation(s)
- Maria J. Monroy‐Iglesias
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR) King's College London London UK
| | - Sonpreet Rai
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | | | | | | | - Beth Russell
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR) King's College London London UK
| | - Charlotte Moss
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR) King's College London London UK
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery European Institute of Oncology IRCCS Milan Italy
| | - Matteo Ferro
- Division of Urology European Institute of Oncology IRCCS Milan Italy
| | - Gennaro Musi
- Division of Urology European Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Haemato‐oncology University of Milan Milan Italy
| | - Christian Brown
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Rajesh Nair
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Ramesh Thurairaja
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Archana Fernando
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Paul Cathcart
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Azhar Khan
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Prokar Dasgupta
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Sachin Malde
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Marios Hadijpavlou
- Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Saoirse Dolly
- Department of Medical Oncology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Kate Haire
- South East London Cancer Alliance London UK
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery European Institute of Oncology IRCCS Milan Italy
- Department of Biomedical Sciences University of Sassari Sassari Italy
| | - Ottavio Cobelli
- Division of Urology European Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Haemato‐oncology University of Milan Milan Italy
| | - Ben Challacombe
- Division of Urology European Institute of Oncology IRCCS Milan Italy
| | - Mieke Van Hemelrijck
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR) King's College London London UK
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Abou-Chedid W, Nason GJ, Evans AT, Yamada K, Moschonas D, Patil K, Langely SE, Perry MJ. The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre. Urologia 2021; 89:495-499. [PMID: 34877900 DOI: 10.1177/03915603211062827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. METHODS A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017-2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a 'clean' site. RESULTS The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. CONCLUSION There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as 'clean' sites can ensure continuity of care for cancer surgery and training needs.
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Affiliation(s)
| | - Gregory J Nason
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Andrew T Evans
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Kohei Yamada
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Krishna Patil
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Stephen E Langely
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Matthew Ja Perry
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
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