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González-Díaz A, Gil-Moradillo J, Rosillo-Ramírez N, Varela-Rodríguez C, Rodríguez-Antolín A, Tejido-Sánchez Á. Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area. J Healthc Qual Res 2022; 37:382-389. [PMID: 35624026 PMCID: PMC9069227 DOI: 10.1016/j.jhqr.2022.03.004] [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] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze surgical safety through postoperative COVID-19 incidence and mortality at the urology department of a tertiary hospital located in Madrid (Spain). METHODS Observational, prospective study including all patients undergoing urological surgery from 1st March 2020 to 28th February 2021. According to the hospital organization and local epidemiological situation we delimitate three epidemic waves. A set of screening and protective measures was applied from 4th May onwards. Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were collected. Telephone follow-up was performed at least 3 weeks after hospital discharge. RESULTS 940 urological surgeries were performed, 12 of them had to be rescheduled due to active or recent SARS-CoV-2 infection identified by the screening protocol. Thirty-one patients developed COVID-19 (3.3% incidence) and 7 died (22.6% mortality). The average time to onset of symptoms was 62.6 days after discharge, being 25 cases attributable to community transmission. The remaining 6 cases, due to in-hospital transmission, had worse outcomes. Five of them were identified during the first wave, especially when no preoperative PCR was obtained. In contrast, during the second and third waves, fewer and milder cases were diagnosed, with just 1 in-hospital transmission among 857 urological patients. CONCLUSIONS After implementing complete protective measures, postoperative in-hospital COVID-19 cases almost disappeared, even during the second and third waves. Most of the cases were due to community transmission and thus driven by the general epidemiological situation. While hospitals follow recommendations to avoid COVID-19 infection, urological surgery remains safe and can be maintained.
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Affiliation(s)
- A González-Díaz
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain.
| | - J Gil-Moradillo
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - N Rosillo-Ramírez
- Preventive Medicine Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - C Varela-Rodríguez
- Quality Healthcare Unit, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - A Rodríguez-Antolín
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - Á Tejido-Sánchez
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
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Malhotra K, Mangwani J, Houchen-Wollof L, Mason LW. Rate of COVID-19 infection and 30 day mortality between blue and green (dedicated COVID-19 safe) pathways: Results from phase 1 and 2 of the UK foot and ankle COVID-19 national (UK-FAlCoN) audit. Foot Ankle Surg 2022; 28:1055-1063. [PMID: PMID: 35256273 PMCID: PMC8872704 DOI: 10.1016/j.fas.2022.02.017] [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: 09/26/2021] [Revised: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The primary aim was to determine the differences in COVID-19 infection rate and 30-day mortality in patients undergoing foot and ankle surgery between different treatment pathways over the two phases of the UK-FALCON audit, spanning the first and second UK national lockdowns. SETTING This was an ambispective (retrospective Phase 1 and prospective Phase 2) national audit of foot and ankle procedures in the UK in 2020 completed between 13th January 2020 and 30th November 2020. PARTICIPANTS All adult patients undergoing foot and ankle surgery in an operating theatre during the study period were included from 46 participating centres in England, Scotland, Wales and Northern Ireland. Patients were categorised as either a green pathway (designated COVID-19 free) or blue pathway (no protocols to prevent COVID-19 infection). RESULTS 10,846 patients were included, 6644 from phase 1 and 4202 from phase 2. Over the 2 phases the infection rate on a blue pathway was 1.07% (69/6470) and 0.21% on a green pathway (9/4280). In phase 1, there was no significant difference in the COVID-19 perioperative infection rate between the blue and green pathways in any element of the first phase (pre-lockdown (p = .109), lockdown (p = .923) or post-lockdown (p = .577)). However, in phase 2 there was a significant reduction in perioperative infection rate when using the green pathway in both the pre-lockdown (p < .001) and lockdown periods (Odd's Ratio 0.077, p < .001). There was no significant difference in COVID-19 related mortality between pathways. CONCLUSIONS There was a five-fold reduction in the perioperative COVID-19 infection rate when using designated COVID-19 green pathways over the whole study period; however the success of the pathways only became significant in phase 2 of the study, where there was a 13-fold reduction in infection rate. The study shows a developing success to using green pathways in reducing the risk to patients undergoing foot and ankle surgery.
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Affiliation(s)
- Karan Malhotra
- Trauma and Orthopaedic Consultant, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - Jitendra Mangwani
- Trauma and Orthopaedic Consultant, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
| | - Linzy Houchen-Wollof
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK
| | - Lyndon W. Mason
- Trauma and Orthopaedic Consultant, Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK,Correspondence to: Trauma and Orthopaedic Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK
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Monroy-Iglesias MJ, Tagliabue M, Dickinson H, Roberts G, De Berardinis R, Russell B, Moss C, Irwin S, Olsburgh J, Cocco IMF, Schizas A, McCrindle S, Nath R, Brunet A, Simo R, Tornari C, Srinivasan P, Prachalias A, Davies A, Geh J, Fraser S, Routledge T, Ma R, Doerge E, Challacombe B, Nair R, Hadjipavlou M, Scarpinata R, Sorelli P, Dolly S, Mistretta FA, Musi G, Casiraghi M, Aloisi A, Dell’Acqua A, Scaglione D, Zanoni S, Rampazio Da Silva D, Brambilla D, Bertolotti R, Peruzzotti G, Maggioni A, de Cobelli O, Spaggiari L, Ansarin M, Mastrilli F, Gandini S, Jain U, Hamed H, Haire K, Van Hemelrijck M. Continuity of Cancer Care: The Surgical Experience of Two Large Cancer Hubs in London and Milan. Cancers (Basel) 2021; 13:cancers13071597. [PMID: 33808375 PMCID: PMC8036608 DOI: 10.3390/cancers13071597] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic is having a large effect on the management of cancer patients. This study reports on the approach and outcomes of cancer patients receiving radical surgery with curative intent between March and September 2020 (in comparison to 2019) in the European Institute of Oncology, IRCCS (IEO) in Milan and the South East London Cancer Alliance (SELCA). Both institutions implemented a COVID-19 minimal pathway where patients were required to self-isolate prior to admission and were swabbed for COVID-19 within 72 h of surgery. Positive patients had surgery deferred until a negative swab. At IEO, radical surgeries declined by 6% as compared to the same period in 2019 (n = 1477 vs. 1560, respectively). Readmissions were required for 3% (n = 41), and <1% (n = 9) developed COVID-19, of which only one had severe disease and died. At SELCA, radical surgeries declined by 34% (n = 1553 vs. 2336). Readmissions were required for 11% (n = 36), <1% (n = 7) developed COVID-19, and none died from it. Whilst a decline in number of surgeries was observed in both centres, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.
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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 WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
- Correspondence: (M.J.M.-I.); (R.D.B.)
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.T.); (M.A.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Harvey Dickinson
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Graham Roberts
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.T.); (M.A.)
- Correspondence: (M.J.M.-I.); (R.D.B.)
| | - Beth Russell
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
| | - Charlotte Moss
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
| | - Sophie Irwin
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Jonathon Olsburgh
- Department of Nephrology and Transplantation, Guy’s & St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Ivana Maria Francesca Cocco
- Department of Colorectal Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (I.M.F.C.); (A.S.)
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (I.M.F.C.); (A.S.)
| | - Sarah McCrindle
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.M.); (S.D.)
| | - Rahul Nath
- Department of Gynaecological Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Aina Brunet
- Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.B.); (R.S.); (C.T.)
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.B.); (R.S.); (C.T.)
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.B.); (R.S.); (C.T.)
| | - Parthi Srinivasan
- Department of Liver Studies, King’s College Hospital, London SE5 9RS, UK; (P.S.); (A.P.)
| | - Andreas Prachalias
- Department of Liver Studies, King’s College Hospital, London SE5 9RS, UK; (P.S.); (A.P.)
| | - Andrew Davies
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Jenny Geh
- Department of Plastic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Stephanie Fraser
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.F.); (T.R.); (R.M.)
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.F.); (T.R.); (R.M.)
| | - RuJun Ma
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.F.); (T.R.); (R.M.)
| | - Ella Doerge
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Ben Challacombe
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Raj Nair
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Marios Hadjipavlou
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Rosaria Scarpinata
- Department of Colorectal Surgery, King’s College Hospital, London SE5 9RS, UK;
| | - Paolo Sorelli
- Department of Colorectal Surgery, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK;
| | - Saoirse Dolly
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.M.); (S.D.)
| | | | - Gennaro Musi
- Division of Urology, European Institute of Oncology IRCCS, 20122 Milan, Italy; (F.A.M.); (G.M.); (O.d.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Alessia Aloisi
- Division of Gynaecological Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (A.A.); (A.D.); (A.M.)
| | - Andrea Dell’Acqua
- Division of Gynaecological Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (A.A.); (A.D.); (A.M.)
| | - Donatella Scaglione
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Stefania Zanoni
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Daniele Rampazio Da Silva
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Daniela Brambilla
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Raffaella Bertolotti
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Giulia Peruzzotti
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Angelo Maggioni
- Division of Gynaecological Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (A.A.); (A.D.); (A.M.)
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology IRCCS, 20122 Milan, Italy; (F.A.M.); (G.M.); (O.d.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.T.); (M.A.)
| | - Fabrizio Mastrilli
- Medical Administration, European Institute of Oncology, IRCCS, 20122 Milan, Italy;
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Urvashi Jain
- Department of Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (U.J.); (H.H.)
| | - Hisham Hamed
- Department of Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (U.J.); (H.H.)
| | - Kate Haire
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Mieke Van Hemelrijck
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
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