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Utku Çelik S, Lapsekili E, Alakuş Ü. Impact of the COVID-19 pandemic on emergency general surgery outcomes: A single-center retrospective cohort study. ULUS TRAVMA ACIL CER 2022; 28:900-910. [PMID: 35775682 PMCID: PMC10493828 DOI: 10.14744/tjtes.2021.89287] [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: 03/23/2021] [Accepted: 05/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected the health-care system unpredictably. Restrictions and precautions have had a significant impact on the volume and nature of admissions in emergency services. In this study, we hypothesized that the pandemic would result in a change in the number of emergencies admitted to the general surgery inpatient service and a worse patient outcome compared to the previous year. METHODS A retrospective analysis of emergency general surgical admissions during the first 6 months of the pandemic and the same period in 2019 was conducted. Demographics, laboratory assessments, diagnosis, treatment strategies, and postoperative out-comes were analyzed. RESULTS 761 patients were admitted to the general surgery service during two 6-month periods (392 vs. 369, respectively). This represented a 5.9% reduction in admissions. However, in the first 2 months of the pandemic, the number of emergency general surgical admissions decreased by 37.1% and 43.7%, respectively. Comparison of periods demonstrated no significant differences in demograph-ics, laboratory values, incidence of emergencies, treatment strategies, and hospital stay. Acute appendicitis, cholecystitis, and bowel obstruction were the three most common surgical emergencies in the pandemic. However, there was no significant difference in outcomes between the periods when each surgical emergency was evaluated separately. CONCLUSION Pandemic appears to affect general surgical admissions with a fluctuating pattern, an increasing trend following a sig-nificant 2-month decrease. These findings suggest that patients presented with a delayed presentation; however, contrary to concerns, there was no difference in patient outcomes between the two periods. This study provides a perspective in management strategies for surgical emergencies in such unusual conditions.
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Affiliation(s)
- Süleyman Utku Çelik
- Department of General Surgery, Health Science University, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Emin Lapsekili
- Department of General Surgery, Health Science University, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Ümit Alakuş
- Division of Gastroenterological Surgery, Department of General Surgery, Health Science University, Gülhane Training and Research Hospital, Ankara-Türkiye
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Turhan N, Arıcan ÇD. The effects of COVID-19 pandemic on patients with acute appendicitis. ULUS TRAVMA ACIL CER 2022; 28:756-761. [PMID: 35652875 PMCID: PMC10443006 DOI: 10.14744/tjtes.2021.53929] [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: 11/12/2020] [Accepted: 02/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effects of the COVID-19 infection on the world's health system began to be reported in a short time, with the spread of the infection all over the world and it gained a global acceptance as a pandemic. It was predicted that patients who require urgent surgical procedures may not be able to access appropriate treatment during this period and may suffer from this process. In this process, we planned to report the effects of the pandemic process to this patient group by evaluating patients with acute appendicitis, which is the most common cause of acute abdomen among general surgery emergencies. METHODS In our study, we compared the patients who applied to the Training and Research Hospital we collaborated, whose clinics were compatible with acute appendicitis, between March 11, 2020, and May 21, 2020, with those applied within the same time period with the year before. We evaluated clinical and pathological findings of the patients and the treatment applied. RESULTS In this study, there were 103 patients diagnosed with acute appendicitis before pandemic and 61 in pandemic period. We found that during the pandemic period, patients with acute appendicitis were admitted to the hospital less often, and in a later period, and more complicated clinical pictures were determined. Complicated appendicitis patients were higher in pandemic period compared with previous year (33.96% vs. 8.00% of patients, respectively; p<0.05). CONCLUSION We emphasized that diseases that need to be treated urgently should not be left behind during the pandemic. Furthermore, we shared our clinical practice to ensure early discharge of patients with acute appendicitis during the pandemic process.
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Affiliation(s)
- Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
| | - Çiğdem Dicle Arıcan
- Department of Medical Pathology, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
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Effect of the COVID-19 Pandemic on Patient Presentation and Perception to a Neurosurgical Outpatient Clinic. World Neurosurg 2021; 149:e274-e280. [PMID: 33610862 PMCID: PMC7891092 DOI: 10.1016/j.wneu.2021.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022]
Abstract
Background The world currently faces the novel COVID-19 pandemic, with cutbacks in patient care. Little is known about the effects of a pandemic on the presentation and admission to an outpatient clinic. Our aim was to gain a better understanding of the effects of reduced neurosurgical care access from the patient perspective, especially in terms of anxiety and urgency of treatment, and to improve outpatient management in case of a potential second wave and potential restrictions on health care. Methods We performed a questionnaire study over a period of 4 weeks following the COVID-19 lockdown at our academic neurosurgical department. A 15-item questionnaire was distributed to the patients with 3 additional questions to be answered by the treating neurosurgeon. Results A total of 437 questionnaires were analyzed. Overall anxiety to visit a general practitioner or the outpatient facility within the hospital was very low among patients. A quarter of all appointments had to be postponed due to COVID-19, in 0.6% postponement was perceived as incorrect by the treating neurosurgeon. We noted that 43% did not get an appointment due to the restrictions, 20% did not want to bother the medical system, and only 4% were afraid to get infected in the hospital. Conclusions Despite COVID-19, patients in need of neurosurgical service were hardly afraid to visit doctors and/or hospitals. Nonetheless, because legal requirements, access has been restricted, causing potential collateral damage in a small subset of neurosurgical patients.
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Willms AG, Oldhafer KJ, Conze S, Thasler WE, von Schassen C, Hauer T, Huber T, Germer CT, Günster S, Bulian DR, Hirche Z, Filser J, Stavrou GA, Reichert M, Malkomes P, Seyfried S, Ludwig T, Hillebrecht HC, Pantelis D, Brunner S, Rost W, Lock JF. Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany. Langenbecks Arch Surg 2021; 406:367-375. [PMID: 33550453 PMCID: PMC7867500 DOI: 10.1007/s00423-021-02090-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/12/2021] [Indexed: 12/22/2022]
Abstract
Purpose The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. Methods Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed. Results A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change. Conclusion The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02090-3.
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Affiliation(s)
- Arnulf G Willms
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany.
| | - Karl J Oldhafer
- Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbeck, Hamburg, Germany
| | - Sophie Conze
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Wolfgang E Thasler
- Abteilung für Allgemein-, Viszeral-, Thorax- und Minimalinvasive Chirurgie, Rot-Kreuz-Klinikum München, München, Germany
| | - Christian von Schassen
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Thorsten Hauer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Tobias Huber
- Klinik für Allgemein-, Viszeral-und Transplantationschirurgie, Universitätsmedizin Mainz, Mainz, Germany
| | - Christoph-Thomas Germer
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Simone Günster
- Operatives Zentrum für Allgemeinchirurgie, Klinikum Fürth, Fürth, Germany
| | - Dirk R Bulian
- Klinik für Viszeral-, Tumor-, Transplantations- und Gefäßchirurgie, Kliniken der Stadt Köln, Standorte Merheim und Holweide, Köln, Germany
| | - Zarah Hirche
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Ludwigshafen am Rhein, Ludwigshafen, Germany
| | - Jörg Filser
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, InnKlinikum Altötting und Mühldorf, Altötting, Germany
| | - Gregor A Stavrou
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie, Chirurgische Onkologie, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Martin Reichert
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Gießen, Germany
| | - Patrizia Malkomes
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Steffen Seyfried
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Tobias Ludwig
- Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany
| | - Hans C Hillebrecht
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Dimitrios Pantelis
- Abteilung für Allgemein- und Viszeralchirurgie, GFO Kliniken Bonn, Bonn, Germany
| | - Stefanie Brunner
- Klinik und Poliklinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Uniklinik Köln, Köln, Germany
| | - Wilm Rost
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Johan F Lock
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
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Madrazo Z, Osorio J, Otero A, Biondo S, Videla S. Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic: A multicenter collaborative retrospective cohort study protocol (COVID-CIR). Medicine (Baltimore) 2021; 100:e24409. [PMID: 33592888 PMCID: PMC7870207 DOI: 10.1097/md.0000000000024409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
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Affiliation(s)
- Zoilo Madrazo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Javier Osorio
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Aurema Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Sebastian Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
- Department of Pathology and Experimental Therapeutics, Faculty of Medicine, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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Navarro F, Jarry C, Gabrielli M. Afterthoughts from an Unexpected Morbidity under COVID-19 pandemic. J INVEST SURG 2020; 35:411-412. [PMID: 33164621 DOI: 10.1080/08941939.2020.1843206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Francisco Navarro
- Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Jarry
- Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Molina Gutiérrez MÁ, Ruiz Domínguez JA, Bueno Barriocanal M, de Miguel Lavisier B, López López R, Martín Sánchez J, de Ceano-Vivas la Calle M. Impact of the COVID-19 pandemic on emergency department: Early findings from a hospital in Madrid. An Pediatr (Barc) 2020; 93:313-322. [PMID: 33020734 PMCID: PMC7526690 DOI: 10.1016/j.anpede.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION SARS-CoV-2, coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in Spain on 31 January 2020. On 14 March 2020, a state of emergency was declared in Spain in a bid to control the spread of the COVID-19 pandemic in the country. The aim of our study is to analyze the impact on emergency medicine attendance after the national lockdown, as well as the clinical presentation and the management of patients with suspected COVID-19 in the Paediatric Emergency Department. PATIENTS AND METHODS This retrospective observational study included children and adolescents under the age of 18, attended in our Paediatric Emergency Department during the period March 14 to April 17, 2020. RESULTS A total of 1666 patients were attended during the study period, 65.4% less than in the same period of 2019. Just over half (51.2%) were males, and mean age was 5.4 years. In triage, 39.9% were high priority levels, 6.5% more than 2019. Most frequent reasons for consultation at the Paediatric Emergency Department were fever (26.5%), respiratory symptoms (16.1%), and trauma (15.2%). A total of 218 patients (13%) received a diagnosis of possible COVID-19, with SARS-CoV-2 infection confirmed in 18.4%, and 23.8% (52/218) were hospitalised. At discharge, 44% (96/218) were diagnosed with lower, and 33.9% (74/218) with upper respiratory infection. CONCLUSIONS During the SARS-CoV-2 outbreak, the demand for urgent paediatric care decreased, with the proportion of cases with high priority triage levels increasing. Most of the patients with suspected or microbiological confirmation of COVID-19 had mild respiratory symptoms.
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Affiliation(s)
| | | | | | | | - Rosario López López
- Servicio de Urgencias Pediátricas, Hospital Universitario La Paz, Madrid, Spain
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Molina Gutiérrez MÁ, Ruiz Domínguez JA, Bueno Barriocanal M, de Miguel Lavisier B, López López R, Martín Sánchez J, de Ceano-Vivas la Calle M. [Impact of the COVID-19 pandemic on emergency department: Early findings from a hospital in Madrid]. An Pediatr (Barc) 2020; 93:313-322. [PMID: 32800720 PMCID: PMC7373010 DOI: 10.1016/j.anpedi.2020.06.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION SARS-CoV-2, coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in Spain on 31 January 2020. On 14 March 2020, a state of emergency was declared in Spain in a bid to control the spread of the COVID-19 pandemic in the country. The aim of our study is to analyse the impact on emergency medicine attendance after the national lockdown, as well as the clinical presentation and the management of patients with suspected COVID-19 in the Paediatric Emergency Department. PATIENTS AND METHODS This retrospective observational study included children and adolescents under the age of 18, attended in our Paediatric Emergency Department during the period March 14 to April 17, 2020. RESULTS A total of 1,666 patients were attended during the study period, 65.4% less than in the same period of 2019. Just over half (51.2%) were males, and mean age was 5.4 years. In triage, 39.9% were high priority levels, 6.5% more than 2019. Most frequent reasons for consultation at the Paediatric Emergency Department were fever (26.5%), respiratory symptoms (16.1%), and trauma (15.2%). A total of 218 patients (13%) received a diagnosis of possible COVID-19, with SARS-CoV-2 infection confirmed in 18.4%, and 23.8% (52/218) were hospitalised. At discharge, 44% (96/218) were diagnosed with lower, and 33.9% (74/218) with upper respiratory infection. CONCLUSIONS During the SARS-CoV-2 outbreak, the demand for urgent paediatric care decreased, with the proportion of cases with high priority triage levels increasing. Most of the patients with suspected or microbiological confirmation of COVID-19 had mild respiratory symptoms.
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Affiliation(s)
| | | | | | | | - Rosario López López
- Servicio de Urgencias Pediátricas, Hospital Universitario La Paz, Madrid, España
| | - Julia Martín Sánchez
- Servicio de Urgencias Pediátricas, Hospital Universitario La Paz, Madrid, España
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Zhou Y, Cen LS. Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China. World J Clin Cases 2020; 8:4349-4359. [PMID: 33083394 PMCID: PMC7559659 DOI: 10.12998/wjcc.v8.i19.4349] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) is a global pandemic and has had a profound impact on our routine surgical activities. Acute appendicitis is the most common abdominal emergency worldwide. Therefore, it is highly essential to assess the influence the pandemic has on acute appendicitis.
AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.
METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing, China. Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019. Preoperative management, intraoperative protective measures, and postoperative management were conducted.
RESULTS After screening, six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group. The results of the nucleic acid test were negative. Of the 76 patients enrolled in the simple group, nine patients received medication therapy, and all others underwent surgery. From this same group, 66 patients were diagnosed with suppurative appendicitis, and one patient was diagnosed with perforated appendicitis after surgery. There were 14 patients in the complex group, for which the postoperative diagnosis indicated perforated appendicitis. The proportion of men with perforated appendicitis was higher than that in 2019 (P < 0.05). The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019 (P < 0.05). The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019 (P < 0.05). The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019 (P < 0.05). Online consultation after discharge was selected in 59 cases (65.6%). No perioperative infection with COVID-19 or long-term postoperative complications were found.
CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.
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Affiliation(s)
- Yuan Zhou
- Department of Gastrointestinal Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing 31400, Zhejiang Province, China
| | - Lu-Sha Cen
- Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Zarzavadjian Le Bian A, Tresallet C, Martinod E. [A crisis of ethics in the ethics of crisis]. ACTA ACUST UNITED AC 2020; 157:371. [PMID: 32834889 PMCID: PMC7388794 DOI: 10.1016/j.jchirv.2020.06.003] [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] [Indexed: 12/02/2022]
Affiliation(s)
- A Zarzavadjian Le Bian
- Service de chirurgie digestive, bariatrique et endocrinienne, hôpital Avicenne, hôpitaux universitaires Seine Saint-Denis, université Sorbonne Paris Nord, Assistance publique-Hôpitaux de Paris, 125, rue de Stalingrad, 93000 Bobigny, France
| | - C Tresallet
- Service de chirurgie digestive, bariatrique et endocrinienne, hôpital Avicenne, hôpitaux universitaires Seine Saint-Denis, université Sorbonne Paris Nord, Assistance publique-Hôpitaux de Paris, 125, rue de Stalingrad, 93000 Bobigny, France
| | - E Martinod
- Service de chirurgie thoracique et vasculaire, hôpital Avicenne, hôpitaux universitaires Seine Saint-Denis, université Sorbonne Paris Nord, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France
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Cano-Valderrama O, Morales X, Ferrigni CJ, Martín-Antona E, Turrado V, García A, Cuñarro-López Y, Zarain-Obrador L, Duran-Poveda M, Balibrea JM, Torres AJ. Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study. Int J Surg 2020; 80:157-161. [PMID: 32679205 PMCID: PMC7361112 DOI: 10.1016/j.ijsu.2020.07.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
| | - Xavier Morales
- Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain
| | | | - Esteban Martín-Antona
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Victor Turrado
- Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain
| | | | | | | | | | - José M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain; Department of Surgery, Universidad Autónoma, Barcelona, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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12
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Zarzavadjian Le Bian A, Tresallet C, Martinod E. A crisis of ethics in the ethics of crisis. J Visc Surg 2020; 157:365-366. [PMID: 32718864 PMCID: PMC7380912 DOI: 10.1016/j.jviscsurg.2020.07.002] [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] [Indexed: 11/28/2022]
Affiliation(s)
- A Zarzavadjian Le Bian
- Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University hospital of Seine Saint-Denis, Digestive, Bariatric and Endocrine Surgery Department, Sorbonne Paris Nord University, 93000 Bobigny, France.
| | - C Tresallet
- Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University hospital of Seine Saint-Denis, Digestive, Bariatric and Endocrine Surgery Department, Sorbonne Paris Nord University, 93000 Bobigny, France
| | - E Martinod
- Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University Hospital of Seine Saint-Denis, Thoracic and Vascular Surgery Department, Sorbonne Paris Nord University, 93000 Bobigny, France
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13
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Solis E, Hameed A, Brown K, Pleass H, Johnston E. Delayed emergency surgical presentation: impact of corona virus disease (COVID-19) on non-COVID patients. ANZ J Surg 2020; 90:1482-1483. [PMID: 32437037 PMCID: PMC7280650 DOI: 10.1111/ans.16048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Edgardo Solis
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ahmer Hameed
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kai Brown
- Department of Surgery - UGI, Westmead Hospital, Sydney, New South Wales, Australia
| | - Henry Pleass
- Department of Surgery - UGI/Transplant, Westmead Hospital, Sydney, New South Wales, Australia
| | - Emma Johnston
- Department of Surgery - UGI, Westmead Hospital, Sydney, New South Wales, Australia
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14
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Pocard M. [A special edition of the Journal of Visceral Surgery on COVID-19: What problems, dangers and solutions have been identified?]. ACTA ACUST UNITED AC 2020; 157:S1-S3. [PMID: 32374298 PMCID: PMC7198195 DOI: 10.1016/j.jchirv.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Pocard
- UMR 1275 CAP Paris-Tech, université de Paris, 75010 Paris, France.,Service de chirurgie digestive et cancérologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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15
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Pocard M. A special edition of the Journal of Visceral Surgery on COVID-19: What problems, dangers and solutions have been identified? J Visc Surg 2020; 157:S1-S3. [PMID: 32402794 PMCID: PMC7198150 DOI: 10.1016/j.jviscsurg.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M Pocard
- UMR 1275 CAP Paris-Tech, université de Paris, 75010 Paris, France; Service de chirurgie digestive et cancérologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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