Colorectal Surgery Outcomes in the United States During the COVID-19 Pandemic

A Prospective Mixed Methods Study on Experiences of Mindfulness Intervention on Pain and Anxiety in Patients Undergoing a Colorectal Surgery

Purpose: To evaluate the effectiveness and experiences of a mindfulness intervention in colorectal surgical patients. Design of Study: Descriptive mixed methods study. Method: Sixteen participants were provided with two or three 15-20-min mindfulness sessions. Data were collected before and after each session on blood pressure, heart and respiratory rate, anxiety, and pain. The participants were interviewed before their discharge. Findings: Eight participants (n = 8) received two and eight (n = 8) three sessions. Decreasing blood pressure and lower heart rates were noted after the sessions. Also, decreasing pain scores were found, especially in participants who attended two sessions. Minor decrease in anxiety scores were noticed in participants who attended three sessions. Two major themes emerged from the interviews: healing and restoration of health and becoming in tune with self. These themes were characterized by study participants' reflections on experience of recovery, progression to physical relaxation, pathway to serenity, awareness of emotions, evolution of perceptions and experiences of mindfulness. Conclusions: The physiological changes to mindfulness intervention, composed of two or three sessions, were minor and challenging to measure to demonstrate effects. However, study participants' experiences were very positive and suggest that this intervention could prove to be beneficial for colorectal surgical patients.

Venous thromboembolism risk in the postoperative interval during the COVID-19 pandemic: meta-analysis

BACKGROUND

During the COVID-19 pandemic, global trends emerged, indicating increased venous thromboembolism (VTE) incidence among postoperative patients, potentially attributable to perioperative COVID-19 infection. However, there are insufficient data on VTE incidence among postoperative patients in the context of the pandemic. The aim of this study was to examine the global incidence of postoperative VTE during the COVID-19 pandemic.

METHODS

A systematic search of MEDLINE and Embase databases, as well as three other registered databases, was conducted from 1 January 2019 to 3 November 2023, with pre-registration in PROSPERO, the international prospective register of systematic reviews (CRD42023460464). Any study reporting patients aged ≥18 years undergoing surgery during the COVID-19 pandemic was included. Outcomes were aggregated absolute and unadjusted relative risks, plus incidence rates per 1000 person-years, of 30- or 90-day postoperative VTE in patients operated on before or during the COVID-19 pandemic and those with or without perioperative COVID-19 infection during the pandemic.

RESULTS

Of 5943 studies, 17 were available for meta-analysis, reporting on 3 035 037 patients. VTE incidence rates in perioperative COVID-19-positive compared with COVID-19-negative patients were significantly higher after total joint arthroplasty (244 (95% c.i. 110 to 541) versus 71 (95% c.i. 47 to 108) per 1000 person-years), other orthopaedic surgery (253 (95% c.i. 240 to 266) versus 138 (95% c.i. 84 to 229) per 1000 person-years), and emergency general and gastrointestinal surgery (474 (95% c.i. 226 to 995) versus 97 (95% c.i. 61 to 157) per 1000 person-years). No significant differences in VTE rates were reported in studies comparing pre-pandemic and pandemic VTE incidence rates.

CONCLUSION

There were consistent increased VTE rates in perioperative COVID-19-positive patients, particularly those undergoing orthopaedic surgery, and emergency general and gastrointestinal surgery. Further investigation is required to delineate postoperative VTE risk and how it varies by COVID-19 variant and vaccination to inform future practice.

Piloting an Assessment Tool to Organize Surgical Care in Armed Conflicts: Findings From Cameroon

INTRODUCTION

Armed conflict is increasing globally and is dramatically disrupting surgical care more than ever before. To address this, the PIPESS (Personnel, Infrastructure, Procedures, Equipment, Supplies, and Standard) tool was designed to facilitate assessment of hospital capacity. It assesses 6 key categories at 3 timepoints: preconflict, during conflict, and postconflict. This tool was piloted to assess the impact of conflict and COVID-19 on surgical care delivery at the Buea Regional Hospital in Cameroon.

METHODS

This was a cross-sectional, qualitative study combining in-depth interviews and on-site observations of the surgical care unit. The data collected during the interviews were then applied to the modified PIPESS tool to calculate a preconflict score based on recall and a during conflict score to quantify differences before and during conflict.

RESULTS

We interviewed 12 key informants: 6 patients, 3 doctors, and 3 other staff. The themes extracted from the preconflict period highlight major barriers including rudimentary prehospital care and referral limitations from remote areas, lack of funding and training, and a demand exceeding the supply of care. COVID-19 resulted in an influx of resources into the region and did not disrupt care to the extent of the conflict. Quantitatively, the PIPESS score for preconflict was 110, and the PIPESS score during conflict was 115, showing an increase in resources, specifically in personnel and infrastructure during conflict.

CONCLUSIONS

The conflict increased the burden on existing health centers and strained resources for trauma care. Paradoxically, surgical resources increased during the conflict likely because of increased international support along with local displacement of staff toward the hospital. Further data should be collected during the postconflict setting.

Short-Stay Left Colectomy for Colon Cancer: Is It Safe?

BACKGROUND

Advances in surgical practices have decreased hospital length of stay (LOS) after surgery. This study aimed to determine the safety of short-stay (≤24-hour) left colectomy for colon cancer patients in the US.

STUDY DESIGN

Adult colon cancer patients who underwent elective left colectomies were identified using the American College of Surgeons NSQIP database (2012 to 2021). Patients were categorized into 4 LOS groups: LOS 1 day or less (≤24-hour short stay), 2 to 4, 5 to 6, and 7 or more. Primary outcomes were 30-day postoperative overall and serious morbidity. Secondary outcomes were 30-day mortality and readmission. Multivariable logistic regression was performed to explore the association between LOS and overall and serious morbidity.

RESULTS

A total of 15,745 patients who underwent left colectomies for colon cancer were identified with 294 (1.87%) patients undergoing short stay. Short-stay patients were generally younger and healthier with lower 30-day overall morbidity rates (LOS ≤1 day: 3.74%, 2 to 4: 7.38%, 5 to 6: 16.12%, and ≥7: 37.64%, p < 0.001). Compared with patients with LOS 2 to 4 days, no differences in mortality and readmission rates were observed. On adjusted analysis, there was no statistical difference in the odds of overall (LOS 2 to 4 days: odds ratio 1.90, 95% CI 1.01 to 3.60, p = 0.049) and serious morbidity (LOS 2 to 4 days: odds ratio 0.86, 95% CI 1.42 to 1.76, p = 0.672) between the short-stay and LOS 2 to 4 days groups.

CONCLUSIONS

Although currently performed at low rates in the US, short-stay left colectomy is safe for a select group of patients. Attention to patient selection, refinement of clinical pathways, and close follow-up may enable short-stay colectomies to become a more feasible reality.