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Karlafti E, Kotzakioulafi E, Peroglou DC, Gklaveri S, Malliou P, Ioannidis A, Panidis S, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. Emergency General Surgery and COVID-19 Pandemic: Are There Any Changes? A Scoping Review. Medicina (B Aires) 2022; 58:1197. [DOI: https:/doi.org/10.3390/medicina58091197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Abstract
Background and Objectives: The pandemic of SARS-CoV-19 has affected the overall spectrum of General Surgery, either in the case management part, or in the type of cases. The purpose of this review is to gather all the parameters affected and to compare these changes between the pandemic period and the corresponding time frame of the previous year. Materials and Methods: A review of literature in two electronic databases (PubMed and Scopus) was performed examining studies during the pre-pandemic (March to May 2019) and pandemic (March to May 2020) period about emergency surgeries. The differences in case presentation in emergency rooms, patient characteristics, length of hospitalization, type of surgery, complications and mortality rate were compared. Results: The comparison of the studies revealed significant results highlighting the differences between the two time periods for each parameter. There has been observed an overall decrease in the number of cases presented for emergency and urgent surgery. In terms of age, sex, and BMI, there were no significant variations amongst the patients. About the length of hospitalization, the patients hospitalized longer during the pandemic period. In terms of pathologies, the most common types of surgery were appendectomy, gastrointestinal, and colorectal resection. Mortality did not differ between the two study periods. Conclusions: COVID-19 affected a large part of Emergency General Surgery mainly concerns the type of operations performed. The hospitalization of patients, the complications that may have arisen and the recognition of emergencies were the most important issues faced by health care officials in hospitals during the period of COVID-19; however, there were parameters like mortality and patients’ characteristics that did not appear to differ with pre-pandemic era.
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Affiliation(s)
- Eleni Karlafti
- Emergency Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Evangelia Kotzakioulafi
- 1st Propaedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Dimitrios-Christos Peroglou
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Styliani Gklaveri
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Petra Malliou
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Aristeidis Ioannidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stavros Panidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Smaro Netta
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Karlafti E, Kotzakioulafi E, Peroglou DC, Gklaveri S, Malliou P, Ioannidis A, Panidis S, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. Emergency General Surgery and COVID-19 Pandemic: Are There Any Changes? A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1197. [PMID: 36143880 PMCID: PMC9505372 DOI: 10.3390/medicina58091197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The pandemic of SARS-CoV-19 has affected the overall spectrum of General Surgery, either in the case management part, or in the type of cases. The purpose of this review is to gather all the parameters affected and to compare these changes between the pandemic period and the corresponding time frame of the previous year. Materials and Methods: A review of literature in two electronic databases (PubMed and Scopus) was performed examining studies during the pre-pandemic (March to May 2019) and pandemic (March to May 2020) period about emergency surgeries. The differences in case presentation in emergency rooms, patient characteristics, length of hospitalization, type of surgery, complications and mortality rate were compared. Results: The comparison of the studies revealed significant results highlighting the differences between the two time periods for each parameter. There has been observed an overall decrease in the number of cases presented for emergency and urgent surgery. In terms of age, sex, and BMI, there were no significant variations amongst the patients. About the length of hospitalization, the patients hospitalized longer during the pandemic period. In terms of pathologies, the most common types of surgery were appendectomy, gastrointestinal, and colorectal resection. Mortality did not differ between the two study periods. Conclusions: COVID-19 affected a large part of Emergency General Surgery mainly concerns the type of operations performed. The hospitalization of patients, the complications that may have arisen and the recognition of emergencies were the most important issues faced by health care officials in hospitals during the period of COVID-19; however, there were parameters like mortality and patients' characteristics that did not appear to differ with pre-pandemic era.
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Affiliation(s)
- Eleni Karlafti
- Emergency Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Evangelia Kotzakioulafi
- 1st Propaedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Dimitrios-Christos Peroglou
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Styliani Gklaveri
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Petra Malliou
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Aristeidis Ioannidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stavros Panidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Smaro Netta
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Hutchings A, Moonesinghe R, Moler Zapata S, Cromwell D, Bellingan G, Vohra R, Moug S, Smart N, Hinchliffe R, Grieve R. Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England. Br J Surg 2022; 109:984-994. [PMID: 35891605 PMCID: PMC9384585 DOI: 10.1093/bjs/znac233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 06/10/2022] [Indexed: 12/23/2022]
Abstract
Background This study assessed the impact of the first COVID-19 wave in England on outcomes for acute appendicitis, gallstone disease, intestinal obstruction, diverticular disease, and abdominal wall hernia. Methods Emergency surgical admissions for patients aged 18 years and older to 124 NHS Trust hospitals between January and June in 2019 and 2020 were extracted from Hospital Episode Statistics. The risk of 90-day mortality after admission during weeks 11–19 in 2020 (national lockdown) and 2019 (pre-COVID-19) was estimated using multilevel logistic regression with case-mix adjustment. The primary outcome was all-cause mortality at 90 days. Results There were 12 231 emergency admissions and 564 deaths within 90 days during weeks 11–19 in 2020, compared with 18 428 admissions and 542 deaths in the same interval in 2019. Overall, 90-day mortality was higher in 2020 versus 2019, with an adjusted OR of 1.95 (95 per cent c.i. 0.78 to 4.89) for appendicitis, 2.66 (1.81 to 3.92) for gallstone disease, 1.99 (1.44 to 2.74) for diverticular disease, 1.70 (1.13 to 2.55) for hernia, and 1.22 (1.01 to 1.47) for intestinal obstruction. After emergency surgery, 90-day mortality was higher in 2020 versus 2019 for gallstone disease (OR 3.37, 1.26 to 9.02), diverticular disease (OR 2.35, 1.16 to 4.73), and hernia (OR 2.34, 1.23 to 4.45). For intestinal obstruction, the corresponding OR was 0.91 (0.59 to 1.41). For admissions not leading to emergency surgery, mortality was higher in 2020 versus 2019 for gallstone disease (OR 2.55, 1.67 to 3.88), diverticular disease (1.90, 1.32 to 2.73), and intestinal obstruction (OR 1.30, 1.06 to 1.60). Conclusion Emergency admission was reduced during the first lockdown in England and this was associated with higher 90-day mortality.
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Affiliation(s)
- Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ramani Moonesinghe
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, NHS foundation Trust, London, UK
| | - Silvia Moler Zapata
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Geoff Bellingan
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, NHS foundation Trust, London, UK
| | - Ravinder Vohra
- Trent Oesophago-Gastric Unit, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Susan Moug
- Department of Colorectal Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Neil Smart
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Richard Grieve
- Correspondence to: Richard Grieve, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK (e-mail: )
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To answer quickly or rigorously? Scientific strategies for the new surgical questions after the emergence of COVID-19. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2022; 100:725-726. [PMID: 35850477 PMCID: PMC9287461 DOI: 10.1016/j.cireng.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022]
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Wanjiang F, Xiaobo Z, Xin W, Ye M, Lihua H, Jianlong W. Application of POSSUM and P-POSSUM scores in the risk assessment of elderly hip fracture surgery: systematic review and meta-analysis. J Orthop Surg Res 2022; 17:255. [PMID: 35526015 PMCID: PMC9077349 DOI: 10.1186/s13018-022-03134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Since Mohamed et al. analyzed 2326 orthopedic cases in 2002 and believed that the POSSUM formula can be directly used to predict postoperative morbidity and mortality in orthopedic patients, applications of POSSUM and P-POSSUM scores in the hip fracture surgery have been mostly reported in the field of orthopedics, but there are still some inconsistencies in the related reports. Methods The electronic library was searched for all literature that met the purpose from its inception to 2021. Relative risk (RR) was selected to evaluate whether the model could be used to assess the risk of surgery in patients with elderly hip fractures. Finally, sensitivity analyses and subgroup analyses were performed. Results Thirteen studies were finally included, including 9 retrospective and 4 prospective studies.The morbidity analysis includes 11 studies, and the result was RR = 1.07 (95% CI 0.93–1.24), The mortality analysis includes 11 studies on POSSUM and 5 studies on P-POSSUM. The results of mortality by POSSUM and by P-POSSUM were RR = 1.93 (95% CI 1.21–3.08) and RR = 1.15 (95% CI 0.89–1.50), respectively. POSSUM had more accuracy to predict mortality for sample < 200 subgroup(RR = 2.45; 95% CI 0.71–8.42) than sample > 200 subgroup(RR = 1.59; 95% CI 1.06–2.40), and in the subgroup of hip fractures that did not distinguish between specific fracture types(RR = 1.69, 95% CI 0.87–3.32) than intertrochanteric neck fracture subgroup(RR = 5.04, 95% CI 1.07–23.75) and femoral femoral fracture subgroup(RR = 1.43,95% CI 1.10–1.84). Conclusion POSSUM can be used to predict morbidity in elderly hip fractures. The P-POSSUM was more accurate in predicting mortality in elderly hip fracture patients compared to the POSSUM, whose predictive value for mortality was influenced by the sample size and type of fracture studied. In addition, we believe that appropriate improvements to the POSSUM system are needed to address the characteristics of orthopedic surgery.
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Affiliation(s)
- Feng Wanjiang
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhang Xiaobo
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wu Xin
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Meng Ye
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huang Lihua
- Center for Experimental Medicine, Third Xiangya Hospital of Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China.
| | - Wang Jianlong
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Chen P. A Commentary on "P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A retrospective cohort study" (Int J Surg 2021; 96:106171). Int J Surg 2022; 98:106241. [PMID: 35139401 PMCID: PMC8817948 DOI: 10.1016/j.ijsu.2022.106241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
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Osorio J, Madrazo Z, Biondo S. [To answer quickly or rigorously? Scientific strategies for the new surgical questions after the emergence of COVID-19]. Cir Esp 2021; 100:725-726. [PMID: 34840337 PMCID: PMC8604713 DOI: 10.1016/j.ciresp.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Javier Osorio
- Servicio de cirugía general y digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Zoilo Madrazo
- Servicio de cirugía general y digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sebastiano Biondo
- Servicio de cirugía general y digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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