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Forssten MP, Kaplan LJ, Tolonen M, Martinez-Casas I, Cao Y, Walsh TN, Bass GA, Mohseni S. Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective. Eur J Trauma Emerg Surg 2023; 49:57-67. [PMID: 36658305 PMCID: PMC9851576 DOI: 10.1007/s00068-022-02149-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/14/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. METHODS Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020-May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. RESULTS Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. CONCLUSION During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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Affiliation(s)
- Maximilian Peter Forssten
- Division of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, USA
| | - Matti Tolonen
- Helsinki University Hospital HUS Meilahden Tornisairaala, Helsinki, Finland
| | - Isidro Martinez-Casas
- Servicio de Cirugía General, Unidad de Cirugía de Urgencias, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Thomas N Walsh
- Royal College of Surgeons in Ireland Medical University, Busaiteen, Bahrain
| | - Gary Alan Bass
- Division of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Örebro, Sweden
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Örebro, Sweden.
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Kovács EH, Tánczos K, Szabó L, Turan C, Dembrovszky F, Ocskay K, Lee BY, Hegyi P, Molnár Z. Higher Dose Anticoagulation Cannot Prevent Disease Progression in COVID-19 Patients: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:2194. [PMID: 36140295 PMCID: PMC9496532 DOI: 10.3390/biomedicines10092194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Implementation of higher dose (HD) thromboprophylaxis has been considered in patients infected with coronavirus disease 2019 (COVID-19). Our aim was to compare HD to standard dose (SD) thromboprophylaxis in COVID-19 patients. The protocol is registered on PROSPERO (CRD42021284808). We searched for randomised controlled studies (CENTRAL, Embase, Medline and medRxviv) that compared HD to SD anticoagulation in COVID-19 and analysed outcomes such as mortality, thrombotic events, bleedings, and disease progression. The statistical analyses were made using the random effects model. Fourteen articles were included (6253 patients). HD compared with SD showed no difference in mortality (OR 0.83 [95% CI 0.54−1.28]). The use of HD was associated with a decreased risk of thrombosis (OR 0.58 [95% CI 0.44−0.76]), although with an increased risk of major bleeding (OR 1.64 [95% CI 1.25−2.16]). The cohort with D-dimer < 1 mg/mL showed no effect (OR 1.19 [95% CI 0.67−2.11]), but in the case of D-dimer > 1 mg/mL, a tendency of lower risk in the HD group was observed (OR 0.56 [95% CI 0.31−1.00]). The need for intubation in moderately ill patients showed a nonsignificant lower likelihood in the HD group (OR 0.82 [95% CI 0.63−1.08]). We cannot advocate for HD in all COVID-19 patients, although it shows some nonsignificant benefits on disease progression in those with elevated D-dimer who do not need ICU admission.
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Affiliation(s)
- Emőke Henrietta Kovács
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Selye János Doctoral College for Advanced Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Krisztián Tánczos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - László Szabó
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Caner Turan
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Klementina Ocskay
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Bo-Young Lee
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Auron M, Porres-Aguilar M, Cameron SJ. COVID-19 and Elevated D-Dimer: A Tale of Caution. J Gen Intern Med 2022; 37:1304-1305. [PMID: 34989999 PMCID: PMC8734549 DOI: 10.1007/s11606-021-07280-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Moises Auron
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Mateo Porres-Aguilar
- Division of Hospital Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Scott J Cameron
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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WITHDRAWN: A dynamic, D-dimer-based thromboprophylaxis strategy in patients with COVID-19. THROMBOSIS UPDATE 2021. [PMCID: PMC8185644 DOI: 10.1016/j.tru.2021.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article has been withdrawn at the request of the author(s). The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Papadakis ES, Norris LA. COVID-19 in 2021 "the end of the beginning". THROMBOSIS UPDATE 2021; 3:100051. [PMID: 38620617 PMCID: PMC8055518 DOI: 10.1016/j.tru.2021.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- E S Papadakis
- Papageorgiou Hospital, Hemostasis Unit-Hematology Department, Thessaloniki, Greece
| | - L A Norris
- Trinity College Dublin, Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James Hospital, Dublin, Ireland
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