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Youshani AS, Whittle C, Ghosh K. A risk assessment strategy to re-introduce elective neurosurgery patients during COVID-19. Br J Neurosurg 2024; 38:476-480. [PMID: 33829937 DOI: 10.1080/02688697.2021.1900540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To demonstrate the utilisation of a risk assessment protocol designed to prioritise elective neurosurgical patients against the risks of COVID-19. This tool can be applied to all other surgical specialties. DESIGN Prospective case series of 166 patients. SETTING Single-centre tertiary neurosurgical department. PARTICIPANTS All patients awaiting an elective neurosurgical procedure were included in this study. All emergency or life-threatening neurosurgical pathologies affecting patients were excluded. MAIN OUTCOME MEASURES The risk assessment tool identified patients with progressive neurology and stratified need for surgery against risk of harm during the COVID-19 pandemic. RESULTS Using our risk stratification tool, 6.6% patients required expedited surgery and a further 11.4% patients were removed completely from the waiting list. The majority of patients 47%, required surgery within 3 months. CONCLUSIONS This simple tool encourages surgical departments to establish contact with patients during COVID-19. The clinician acquires up-to-date information regarding patient symptomatology and subsequently determines surgical priority, a timescale required for surgery and overall uses of NHS resources efficiently. We recommend the use of this tool for all neurosurgical departments, with a wider application to other surgical specialties during the ongoing pressures of elective backlogs secondary to the persistent COVID-19 pandemic.
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Affiliation(s)
- Amir Saam Youshani
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Chelsea Whittle
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Kaushik Ghosh
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Curfman KR, Blair GE, Kosnik CL, Pille SA, Parsons ME, Shah CA, Neighorn CC, Rashidi L. Same day discharge colon surgery: is it financially worth it? Colorectal Dis 2024; 26:669-674. [PMID: 38372024 DOI: 10.1111/codi.16916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/29/2023] [Accepted: 01/13/2024] [Indexed: 02/20/2024]
Abstract
AIM Same day discharge (SDD) for colorectal surgery shows increasing promise in the era of enhanced recovery after surgery protocols and minimally invasive surgery. It has become increasingly relevant due to the constraints posed by the COVID-19 pandemic. The aim of this study was to compare SDD and postoperative day 1 (POD1) discharge to understand the clinical outcomes and financial impact on factors such as cost, charge, revenue, contribution margin and readmission. METHOD A retrospective review of colectomies was performed at a single institution over a 2-year period (n = 143). Two populations were identified: SDD (n = 51) and POD1 (n = 92). Patients were selected by International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) and Diagnosis Related Grouper (DRG) codes. RESULTS There was a statistically significant difference favouring SDD in total hospital cost (p < 0.0001), average direct costs (p < 0.0001) and average charges (p < 0.0016). SDD average hospital costs were $8699 (values in USD throughout) compared with $11 652 for POD 1 (p < 0.0001), and average SDD hospital charges were $85 506 compared with $97 008 for POD1 (p < 0.0016). The net revenue for SDD was $22 319 while for POD1 it was $26 173 (p = 0.14). Upon comparison of contribution margins (SDD $13 620 vs. POD1 $14 522), the difference was not statistically significant (p = 0.73). There were no identified statistically significant differences in operating room time, robotic console time, readmission rates or surgical complications. CONCLUSIONS Amidst the pandemic-related constraints, we found that SDD was associated with lower hospital costs and comparable contribution margins compared with POD1. Additionally, the study was unable to identify any significant difference between operating time, readmissions, and surgical complications when performing SDD.
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Misenhimer JJ, Leeds SG, Shabbir R, Jefferies RS, Ogola GO, Ward MA. The impact of COVID-19 on surgical cases at a large quaternary referral hospital. Proc AMIA Symp 2024; 37:408-412. [PMID: 38628336 PMCID: PMC11018017 DOI: 10.1080/08998280.2024.2313341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/24/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Coronavirus-19 (COVID) stressed healthcare systems by increasing hospital admissions and in-hospital mortality. The impact of COVID on surgical patients is unknown. The purpose of this study was to evaluate how the COVID pandemic affected surgical patients at a large quaternary referral hospital. Methods A retrospective review of patients undergoing surgical procedures was performed to evaluate patients undergoing surgery. The impact of COVID on surgical patients was divided into four timeframes based on government regulations: pre-COVID (January 1, 2020 to March 15, 2020), suspended (March 16, 2020 to May 4, 2020), backlogged cases (May 5, 2020 to June 14, 2020), and restoration (June 15, 2020 to September 30, 2020). Differences between patient characteristics and outcomes during these timeframes were evaluated. Results A total of 21,424 surgical cases were performed between January 1, 2020 and September 30, 2020. During the suspended timeframe (when all elective cases were cancelled), the percentage of surgeries increased in men (53.8% compared to 49.2% pre-COVID; P < 0.01), in Black and Hispanic patients (23.1% and 15.3%, respectively; P < 0.05), and in Medicaid and self-pay patients (16.3% compared to 9.9% pre-COVID; P < 0.01). All service lines experienced similar trends in overall case volume except obstetrics (constant), trauma, vascular, and thoracic (which increased during the suspended timeframe). Conclusions COVID-19 induced stresses in surgical patients, altering payor mix and impacting minority groups at a large quaternary referral hospital.
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Affiliation(s)
| | - Steven G. Leeds
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, Texas, USA
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Rehma Shabbir
- Baylor Scott and White Health Research Institute, Dallas, Texas, USA
| | | | - Gerald O. Ogola
- Baylor Scott and White Health Research Institute, Dallas, Texas, USA
| | - Marc A. Ward
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, Texas, USA
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, Texas, USA
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Atary M, Abu-Rmeileh NME. The Effect of the COVID-19 Pandemic on Palestinian Patients Attending Selected Governmental Hospitals: An Analysis of Hospital Records. Int J Environ Res Public Health 2024; 21:196. [PMID: 38397686 PMCID: PMC10888243 DOI: 10.3390/ijerph21020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Confronting the COVID-19 epidemic forced the closure or relocation of the majority of health facilities. It is likely that non-COVID-19 patients suffered collateral effects. METHODS The clinic and operating room records were analyzed at selected Palestinian government hospitals in the West Bank region. RESULTS The reduction in patient clinic visits varied from 49% to 90%, with Ear-Nose-Throat (ENT), urology, and pediatric clinics being the most affected. The reduction in operation numbers in the center (which had independent decision-making) ranged from 7.1% to 23.4%, but in the north and south (which followed centralized choices), the reduction ranged from 19.6% to 91.8%. CONCLUSIONS COVID-19 affected outpatient visits. The pandemic affected some services, but West Bank hospitals were able to provide normal obstetric and gynecological treatments and help patients who needed primary or intermediate surgery.
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Affiliation(s)
- Mousa Atary
- Institute of Community and Public Health, Birzeit University, Ramallah P.O. Box 14, Palestine;
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Mullen AN, Wieser E. Improvement of operating room air quality and sustained reduction of surgical site infections in an orthopedic specialty hospital. Am J Infect Control 2024; 52:183-190. [PMID: 37276956 DOI: 10.1016/j.ajic.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Surgical site infection (SSI) rates can be impacted by air quality, and a high-efficiency particulate air and ultraviolet air recirculation system (HUAIRS) has been shown to improve operating room air quality. This study examined the impact of HUAIRS devices on SSI rates when used at an orthopedic specialty hospital. METHODS HUAIRS devices were used intraoperatively at the facility. Total particle counts before and after HUAIRS implementation were compared. SSI rates for nervous system procedures or for all procedures at the facility were also compared for the 2.5-year periods before and after implementing HUAIRS devices. RESULTS Over 30,000 consecutive procedures were performed from 2017 to 2022. The overall SSI rate at the facility was 0.45% before implementing HUAIRS devices compared to 0.22% (P < 0.001) after. The SSI rate following nervous system procedures was 2.06% before implementing HUAIRS devices versus 0.29% (P < .001) after. Total particle counts were also significantly lower after implementing HUAIRS devices. DISCUSSION AND CONCLUSIONS Implementation of HUAIRS devices at an orthopedic specialty hospital is associated with significant reductions in SSI rates and intraoperative air contamination levels. These data support the need to further investigate intraoperative air quality interventions for the reduction in SSI rates.
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Affiliation(s)
- Anildaliz N Mullen
- Baylor Scott & White Health, Baylor Scott & White Orthopedic and Spine Hospital, Arlington, TX.
| | - Eric Wieser
- Baylor Scott & White Health, Baylor Scott & White Orthopedic and Spine Hospital, Arlington, TX
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Holtestaul T, Vu M, Pak G, Curfman K, Blair G, Kosnik C, Pille S, Rashidi L. Same day discharge in colorectal surgery: Who requires unplanned overnight monitoring? Am J Surg 2024; 227:213-217. [PMID: 38587048 DOI: 10.1016/j.amjsurg.2023.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND Enhanced Recovery After Surgery protocols and minimally invasive surgery have decreased colorectal length of stay. Our institution implemented a Same Day Discharge (SDD) colorectal protocol, and this study evaluates factors associated with unplanned admission. METHODS . Retrospective review was performed from February 2019 to January 2022. Admitted SDD candidates were identified, and their course evaluated. Demographics, clinical characteristics, and outcomes were compared between cohorts. RESULTS Review identified 152 potential SDD patients, 47 successfully discharged. Of the 105 admitted patients, the most common reasons were operative complexity (47.6 %) and social reasons (23.8 %). No differences were seen in operative times, gender, BMI, anticoagulation, or diabetes. The admission cohort was more likely to undergo low anterior resection or right colectomy and was older in age. Case complexity was the highest factor for affecting discharge. CONCLUSION SDD can be feasible after colectomy, but in certain patients may require deviation. The most common factors requiring admission were complexity and social factors.
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Affiliation(s)
| | - Michael Vu
- Madigan Army Medical Center, Tacoma, WA, USA
| | - Grace Pak
- Madigan Army Medical Center, Tacoma, WA, USA
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Shah S, Kapur A, Young A, Boele F, Bekker H, Pompili C. Healthcare professional experiences of making surgical oncology decisions and delivering COVID-19 safe care: a qualitative study. Acta Chir Belg 2023; 123:640-646. [PMID: 36089887 DOI: 10.1080/00015458.2022.2122313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic was declared a public health emergency in March 2020. The British National Health Service (NHS) redirected medical attention towards prioritising COVID-19-positive patients in favour of less urgent care affecting cancer service provision. This study aims to explore experiences of healthcare professionals (HCPs) and investigate the impact of COVID-19 on decision-making in surgical oncology. METHODS HCPs with experience in surgical oncology were recruited from January 2021 to June 2021. Qualitative semi-structured telephone interviews were conducted and transcribed verbatim. Interviews were conducted until data saturation. Thematic analysis was used to identify frequently discussed themes. RESULTS A total of 13 participants were interviewed, identifying three main pandemic-related challenges: multi-disciplinary team (MDT) processes - telephone pre-operative assessments impoverished information elicited from in-person examination; service delivery - personal protective equipment (PPE) added complexity to surgical practice and more difficult communication; work routines - increased workload to deliver COVID-safe remote practices and decreased training time. CONCLUSIONS COVID-19 influenced cancer service provision with teams making significant changes to ensure that effective clinical reasoning and surgical standards were maintained. Managing safe COVID-19 surgical care impacted daily-life and work stressors. Post crisis, service delivery is looking to integrate telemedicine within care whilst reducing its impact on workload and in-practice training.
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Affiliation(s)
- Salonee Shah
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alanah Kapur
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alastair Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
| | - Florien Boele
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Hilary Bekker
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cecilia Pompili
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Liu R, Gutiérrez R, Mather RV, Stone TAD, Santa Cruz Mercado LA, Bharadwaj K, Johnson J, Das P, Balanza G, Uwanaka E, Sydloski J, Chen A, Hagood M, Bittner EA, Purdon PL. Development and prospective validation of postoperative pain prediction from preoperative EHR data using attention-based set embeddings. NPJ Digit Med 2023; 6:209. [PMID: 37973817 PMCID: PMC10654400 DOI: 10.1038/s41746-023-00947-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
Preoperative knowledge of expected postoperative pain can help guide perioperative pain management and focus interventions on patients with the greatest risk of acute pain. However, current methods for predicting postoperative pain require patient and clinician input or laborious manual chart review and often do not achieve sufficient performance. We use routinely collected electronic health record data from a multicenter dataset of 234,274 adult non-cardiac surgical patients to develop a machine learning method which predicts maximum pain scores on the day of surgery and four subsequent days and validate this method in a prospective cohort. Our method, POPS, is fully automated and relies only on data available prior to surgery, allowing application in all patients scheduled for or considering surgery. Here we report that POPS achieves state-of-the-art performance and outperforms clinician predictions on all postoperative days when predicting maximum pain on the 0-10 NRS in prospective validation, though with degraded calibration. POPS is interpretable, identifying comorbidities that significantly contribute to postoperative pain based on patient-specific context, which can assist clinicians in mitigating cases of acute pain.
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Affiliation(s)
- Ran Liu
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rodrigo Gutiérrez
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rory V Mather
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, US
| | - Tom A D Stone
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura A Santa Cruz Mercado
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kishore Bharadwaj
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jasmine Johnson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Proloy Das
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gustavo Balanza
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ekenedilichukwu Uwanaka
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin Sydloski
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew Chen
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mackenzie Hagood
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Urbonas T, Lakha AS, King E, Pepes S, Ceresa C, Udupa V, Soonawalla Z, Silva MA, Gordon-Weeks A, Reddy S. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg 2023; 17:23. [PMID: 37644474 PMCID: PMC10466851 DOI: 10.1186/s13037-023-00368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. RESULTS We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. CONCLUSIONS Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
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Affiliation(s)
- Tomas Urbonas
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adil Siraj Lakha
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Emily King
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Sophia Pepes
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Carlo Ceresa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Venkatesha Udupa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Zahir Soonawalla
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Michael A Silva
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Alex Gordon-Weeks
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Srikanth Reddy
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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Ahmed S, Karim A, Chowdhury TK, Pulock OS, Tamanna N, Akter M, Biswas P, Afroz F, Pinky SD, Alabbi AN, Jamil TR, Tasnim Z, Dev D, Marma M, Aziz TT, Hakim HAN, Basher AKMK, Shahin NHB, Banu T. Patients' characteristics and 30-day mortality for those undergoing elective surgeries during the COVID-19 pandemic in Bangladesh. PLoS One 2023; 18:e0289878. [PMID: 37578982 PMCID: PMC10424860 DOI: 10.1371/journal.pone.0289878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021. METHODS This serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients. RESULTS The prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery. CONCLUSIONS This study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.
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Affiliation(s)
- Shakera Ahmed
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Anwarul Karim
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Tanvir Kabir Chowdhury
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | - Nowrin Tamanna
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- University of South Carolina, Columbia, SC, United States of America
| | - Mastura Akter
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Puja Biswas
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Fahmida Afroz
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | - Zarin Tasnim
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Dipa Dev
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Mraching Marma
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | | | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
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Jothimani D, Simon E, Palanichamy S, Murugesan S, Ramachandran H, Sridhar V, Rajakumar A, Kaliamoorthy I, Narasimhan G, Rela M. Outcome of Patients Waitlisted for Deceased Donor Liver Transplantation During COVID-19 Pandemic: A Single-Center Experience. J Clin Exp Hepatol 2023; 13:601-607. [PMID: 36846504 PMCID: PMC9937687 DOI: 10.1016/j.jceh.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/21/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Background and aim COVID-19 pandemic has strained several healthcare resources across the world. While liver transplantation (LT) is the only curative therapy for patients with end-stage liver disease, we aimed to determine the clinical outcome of patients waitlisted for deceased donor liver transplantation (DDLT) during COVID-19 pandemic. Methods A retrospective comparative observational study of adult patients waitlisted for DDLT from January 2019 to January 2022 at our liver unit (Dr Rela Institute and Medical Center, Chennai, Tamil Nadu, India) was carried out. Patient demographics, disease etiology, Model for End-Stage Liver Disease - Sodium (MELD-Na) score were calculated for all patients listed during the study period. Clinical event was defined as number of DDLT, death in the absence of transplant, and patients awaiting LT were compared. Statistical analysis was performed with SPSS V24.0. Results In total, 310 patients were waitlisted for DDLT, of whom 148, 63, and 99 patients listed during 2019, 2020, and 2021 (till January 2022), respectively; 22 (53.6%), 10 (24.3%), and 9 (21.9%) patients underwent DDLT in the year 2019, 2020, and 2021 (P = 0.000); 137 patients (44.19%) died on the DDLT waitlist of whom 41 (29.9%), 67 (48.9%), and 29 (21.1%) in the year 2019, 2020, and 2021 (P = 0.000), respectively. Waitlist mortality was significantly higher during the COVID first wave. Conclusion COVID-19 pandemic has significantly impacted patients waitlisted for DDLT in India. With limited access to healthcare facilities and decreased organ donation rates during the pandemic, there was a considerable reduction in the patients waitlisted for DDLT, lesser number of patients underwent DDLT, and higher waitlist mortality during the pandemic year. Efforts to improve organ donation in India should be strongly implemented.
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Affiliation(s)
- Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Evangeline Simon
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Swetha Palanichamy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Sivakumar Murugesan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Hemalatha Ramachandran
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Vaasudevan Sridhar
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Akila Rajakumar
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Ilankumaran Kaliamoorthy
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Gomathy Narasimhan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
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Hozesorkhi RM, Vafsi SB, Mohammadimehr M, Kazemi-Galougahi MH, Ebadi A, Afzal M. Development and Psychometric Properties of the Caring Behaviors of Operating Room Nurses Questionnaire during the COVID-19 Pandemic: A Mixed-Method Study. Iran J Nurs Midwifery Res 2023; 28:417-425. [PMID: 37694210 PMCID: PMC10484380 DOI: 10.4103/ijnmr.ijnmr_215_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 09/12/2023]
Abstract
Background Considering the threats in the operating room during the COVID-19 pandemic, the optimal care and safety of the operating room nurses should be maintained when performing surgery on an acute respiratory patient. It seems necessary to design a tool to measure the caring behaviors of operating room nurses. Therefore, the present study was conducted with the aim to design a valid and reliable tool for measuring the caring behavior of operating room nurses during the COVID-19 pandemic. Materials and Methods In this sequential, exploratory, mixed-method study, the designing and psychometric evaluation of the caring behaviors of operating room nurses questionnaire during the COVID-19 pandemic were performed in qualitative and quantitative phases from August 2021 to July 2022 in Aja University of Medical Sciences, Iran. In the qualitative phase, the concept of caring behaviors of operating room nurses was explored through interviews and a literature review based on online searches. In the quantitative phase, validity (face, content, and construct), and reliability of the questionnaire were evaluated. Results The findings supported 21 items in the 5 factors of caring behaviors related to attitude toward patients, knowledge of surgical care, virus prevention principles, self-care knowledge, and self-care performance, which explained 35.92 of the total variance. Scale-Content Validity Index/Average and Cronbach's alpha were calculated to be 0.93 and 0.89, respectively. Conclusions Given its desirable reliability and validity, simple scoring, and ease of use by operating room nurses, the Caring Behaviors of Operating Room Nurses Questionnaire is applicable and its use is recommended.
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Affiliation(s)
| | - Saeed Babajani Vafsi
- Department of Operating Room Technology, Faculty of Paramedical Sciences, Aja University of Medical Sciences, Tehran, Iran
| | - Mojgan Mohammadimehr
- Associated Professor, Department of Laboratory Sciences, Faculty of Paramedicine, Aja University of Medical Sciences, Tehran, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style institute, Baqiyatallah University of Medical Sciences, Tehran, IR Iran- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mahboobeh Afzal
- Department of Emergency Medicine, School of Paramedical, Aja University of Medical Sciences, Tehran, Iran
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13
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El Shikieri AB. Impact of food insecurity and its influencing factors on the risk of malnutrition among COVID-19 patients. PLoS One 2023; 18:e0287311. [PMID: 37319179 PMCID: PMC10270634 DOI: 10.1371/journal.pone.0287311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Few studies focused on the impact of food insecurity severity on the risk of malnutrition among COVID-19 patients in Saudi Arabia. OBJECTIVES This study described the prevalence of food insecurity among COVID-19 patients, its severity, and its associated factors. Additionally, the impact of the severity of food insecurity on the risk of malnutrition was determined. It is hypothesized that food insecurity is associated with an increased risk of malnutrition among COVID-19 patients. METHOD A cross-sectional study was conducted in Al Madinah Al Munawarah in Saudi Arabia. Patients with confirmed COVID-19 and acute severe or nonsevere illness were enrolled. The Food Insecurity Experience Scale was used to determine the severity of food insecurity, and risk of malnutrition was assessed using the Malnutrition Screening Tool. Demographic characteristics, history of medical conditions, food intake, and body mass index (BMI) were assessed. RESULTS A total of 514 patients were enrolled, with 391 (76%) having acute nonsevere COVID-19 symptoms. A total of 14.2% of patients suffered from food insecurity. Of these, 17% had severe symptoms. The severity of food insecurity was influenced by patients' education (P = 0.02, 95% CI 0.019-0.225), weight loss (P = 0.0001, 95% CI 0.252-0.752), and loss of appetite (P = 0.0001, 95% CI 0.293-0.604). Fifteen percent of patients were at risk of malnutrition. Many obese patients suffered from severe COVID-19 symptoms (P = 0.029, 95% CI 0.02-0.539). The risk of malnutrition was associated with the severity of food insecurity (P = 0.001, 95% CI -0.056- -0.014), BMI (P = 0.049, 95% CI 0.000-0.042), and employment status (P = 0.034, 95% CI 0.002-0.048). CONCLUSION Food insecurity and the risk of malnutrition among COVID-19 patients should be assessed to prevent adverse health outcomes.
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Affiliation(s)
- Ahlam Badreldin El Shikieri
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
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14
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Hu Z, Youn HM, Quan J, Lee LLS, Mak IL, Yu EYT, Chao DVK, Ko WWK, Wong ICK, Lau GKK, Lau CS, Lam CLK, Wan EYF. The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis. Prim Care Diabetes 2023; 17:229-237. [PMID: 36872178 PMCID: PMC9977626 DOI: 10.1016/j.pcd.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection. METHODS PubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity. RESULTS Eleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI -0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI -0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride. CONCLUSIONS This review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022360433.
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Affiliation(s)
- Zhuoran Hu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Hin Moi Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jianchao Quan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Lily Luk Siu Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - David Vai-Kiong Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong Hospital Authority, Hong Kong Special Administrative Region of China
| | - Welchie Wai Kit Ko
- Department of Family Medicine and Primary Health Care, Hong Kong Hospital Authority West Cluster, Hong Kong Special Administrative Region of China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Gary Kui Kai Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China.
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15
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de Bock E, Filipe MD, Herman ES, Pronk A, Boerma D, Heikens JT, Verheijen PM, Vriens MR, Richir MC. Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study. Int J Surg Open 2023; 55:100620. [PMID: 37163195 PMCID: PMC10159662 DOI: 10.1016/j.ijso.2023.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
Background During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic. Methods This multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals. Results One hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06-9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32-0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02-1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02-1.08; p = 0.001), surgical urgency and surgical discipline. Conclusion A confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Eline S Herman
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joost T Heikens
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, the Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
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16
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Haribhai S, Bhatia K, Shahmanesh M. Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review. PLOS Glob Public Health 2023; 3:e0001413. [PMID: 37014874 PMCID: PMC10072489 DOI: 10.1371/journal.pgph.0001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
Globally, 28.4 million non-emergent ('elective') surgical procedures have been deferred during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on elective breast- or colorectal cancer (CRC) procedure backlogs and attributable mortality, globally. Further, we evaluated the interaction between procedure deferrals and health systems, internationally. Relevant articles from any country, published between December 2019-24 November 2022, were identified through searches of online databases (MEDLINE, EMBASE) and by examining the reference lists of retrieved articles. We organised health system-related findings thematically per the Structures-Processes-Outcomes conceptual model by Donabedian (1966). Of 337 identified articles, we included 50. Eleven (22.0%) were reviews. The majority of included studies originated from high-income countries (n = 38, 76.0%). An ecological, modelling study elucidated that global 12-week procedure cancellation rates ranged from 68.3%-73%; Europe and Central Asia accounted for the majority of cancellations (n = 8,430,348) and sub-Saharan Africa contributed the least (n = 520,459). The percentage reduction in global, institutional elective breast cancer surgery activity ranged from 5.68%-16.5%. For CRC, this ranged from 0%-70.9%. Significant evidence is presented on how insufficient pandemic preparedness necessitated procedure deferrals, internationally. We also outlined ancillary determinants of delayed surgery (e.g., patient-specific factors). The following global health system response themes are presented: Structural changes (i.e., hospital re-organisation), Process-related changes (i.e., adapted healthcare provision) and the utilisation of Outcomes (i.e., SARS-CoV-2 infection incidence among patients or healthcare personnel, postoperative pulmonary complication incidence, hospital readmission, length of hospital stay and tumour staging) as indicators of health system response efficacy. Evidence on procedure backlogs and attributable mortality was limited, partly due to insufficient, real-time surveillance of cancer outcomes, internationally. Elective surgery activity has decreased and cancer services have adapted rapidly, worldwide. Further research is needed to understand the impact of COVID-19 on cancer mortality and the efficacy of health system mitigation measures, globally.
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Affiliation(s)
- Sonia Haribhai
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, Durban, South Africa
| | - Komal Bhatia
- Institute for Global Health, University College London, London, United Kingdom
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, Durban, South Africa
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17
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Hussain MM, Zaida SAA, Khalil M, Baqai W, Laghari AA, Bari E. Tailoring of neurosurgical practice during COVID-19 in a developing country: Insights gained and a way forward. Surg Neurol Int 2023; 14:117. [PMID: 37151428 PMCID: PMC10159316 DOI: 10.25259/sni_116_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Background:
The coronavirus disease-19 pandemic has aggravated the already neglected neurosurgical specialty in developing countries with a mounting shortage of specialists, long queues of operative patients, and a lack of adequate critical care units.
Methods:
We have reviewed the innovative strategies adopted for maintaining an optimal surgical practice while ensuring team safety at the Aga Khan University Hospital, Karachi Pakistan.
Results:
There is already a scarcity of resources in developing countries. The international guidelines had to be tailored to the context of the developing world. A multimodal strategy that focused on infection control, continuum of care, and the well-being of staff was adopted at Aga Khan University. Patients were screened and seen either in person or through telemedicine, depending on the severity of the disease. All educational activities for residents were shifted online, and this helped in preventing overcrowding.
Conclusion:
Optimal surgical practice while ensuring team safety can be achieved through a multimodal strategy focusing on infection control, continuum of care, and the well-being of staff.
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Chaves CER, Girón F, Núñez-Rocha RE, Benítez E, Ruiz S, Rodríguez L, Ayala D, Villamil CJ, Galvis V, Vanegas M, Gómez M, Nassar R, Hernández JD, Conde D, Zuleta MG. Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study. BMC Surg 2023; 23:56. [PMID: 36918843 PMCID: PMC10011775 DOI: 10.1186/s12893-023-01933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/03/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. STUDY DESIGN A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. RESULTS 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado's score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02-0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54-0.86). CONCLUSION Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Department of Surgery and Specialties, Pontificia Universidad Javeriana, Cra 6A #51A-48, 110100, Bogotá D.C, Colombia.
| | - Felipe Girón
- Department of Surgery, Fundación Santa Fé de Bogotá, Bogotá D.C, Colombia.,School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia.,School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Elkin Benítez
- School of Medicine, Fundación Universitaria Juan N. Corpas, Bogotá D.C, Colombia
| | - Saralia Ruiz
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Lina Rodríguez
- School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia
| | - Daniela Ayala
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Valentina Galvis
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Marco Vanegas
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Mónica Gómez
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Ricardo Nassar
- Department of Surgery, Fundación Santa Fé de Bogotá, Bogotá D.C, Colombia.,School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia.,School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Danny Conde
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia.,Hospital Universitario Mayor, Méderi, Universidad El Rosario, Bogotá D.C, Colombia
| | - María Gómez Zuleta
- Department of Surgery and Specialties, Pontificia Universidad Javeriana, Cra 6A #51A-48, 110100, Bogotá D.C, Colombia
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Agarwal R, Mudgal S, Arnav A, Ranjan N. Coronary artery bypass grafting in active or recent COVID-19 infection: a systematic review. Indian J Thorac Cardiovasc Surg 2023. [PMCID: PMC9995725 DOI: 10.1007/s12055-023-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Introduction Even though there have been few studies on coronary artery bypass grafting (CABG), data on patients with coronavirus disease-2019 (COVID-19) infection show that cardiac surgery has poor outcomes in this subset. From the available studies in the literature, we conducted a systematic review with the aim of determining the outcome of COVID-19 patients who underwent CABG. Methods Between December 2019 and October 2022, searches were conducted in PubMed, the Directory of Open Access Journals, and Google Scholar to find studies reporting results of COVID-19 patients undergoing CABG. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. The quality of the studies was assessed using a standardised tool. Results The total sample size across the 12 included studies was 99 patients who underwent CABG in active disease or within 30 days of COVID-19 infection. The median and interquartile range (IQR) for the length of time spent on a mechanical ventilator, stay in the intensive care unit (ICU), and the total hospital stay were 0.9 (0.47–2), 4.5 (2.5–8), and 12.5 (8.5–22.5) days respectively. Seventy-six patients developed postoperative complications, and there were eleven deaths. Conclusion The findings of the present study indicate that mortality risk goes down when the time between COVID-19 diagnosis and surgery increases. When compared to data from other high-risk urgent or emergent CABG patients around the world who were not infected with COVID-19, patients who underwent CABG in the COVID-19 subgroup had similar postoperative outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01495-7.
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Affiliation(s)
- Rajat Agarwal
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences (AIIMS) Deoghar, PTI Campus, Jasidih, Deoghar, 814142 Jharkhand India
| | - Shiv Mudgal
- grid.413618.90000 0004 1767 6103College of Nursing, All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, Jharkhand 814142 India
| | - Amiy Arnav
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, Jharkhand 814142 India
| | - Nishit Ranjan
- grid.413618.90000 0004 1767 6103Department of General Surgery, All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, Jharkhand 814142 India
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Zambito G, Fritz G, Banks-Venegoni A. A fast tract to foregut surgery: Pandemic-driven protocol development. Am J Surg 2023; 225:481-484. [PMID: 36653268 PMCID: PMC9825138 DOI: 10.1016/j.amjsurg.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND COVID-19 has overwhelmed many health care systems which has affected the landscape of elective surgery. A pandemic driven protocol was developed to perform foregut surgeries as a Same Day Surgery (SDS) discharge for all comers to reduce resource utilization. METHODS Retrospective review of all patients who underwent elective laparoscopic foregut surgery (hiatal hernia, paraesophageal hernia, heller myotomy, and fundoplication) from 8/1/2020-1/31/2022 by a single surgeon after the implementation of a SDS protocol. Patients were compared to a pre-pandemic cohort, from 8/1/2019-4/30/2020, when overnight admission was standard practice. RESULTS There were 36 pre-pandemic patients, and 41 pandemic patients successfully discharged the same day of surgery. We failed to detect a statistically significant difference between the two groups regarding 30-day ED visit rate (p-value of 0.4557) and 30-day readmission rate (p-value of 0.6790). CONCLUSION The creation of a SDS protocol for foregut surgery is a safe way to deliver much needed care to the community while decreasing resource utilization.
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Affiliation(s)
- Giuseppe Zambito
- Spectrum Health Medical Group Department of Surgery, United States.
| | - Gregory Fritz
- Spectrum Health Medical Group Department of Surgery, United States
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21
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Chaudhury S, Myatt R, Aboelmagd T, Hussain M, Malhas A. Two-year clinical and radiographic outcomes following uncemented reverse shoulder replacements for proximal humerus fractures. J Shoulder Elbow Surg 2023; 32:636-644. [PMID: 36243300 DOI: 10.1016/j.jse.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Uncertainty remains regarding the role and long-term outcomes following uncemented reverse shoulder replacements (RSRs) in managing displaced proximal humeral fractures (PHFs). Although RSRs for trauma have traditionally undergone cemented fixation of the humeral component, there is increasing interest in uncemented RSRs. Our primary aim was to evaluate 2-year outcomes following uncemented RSR fixation for 3- and 4-part PHFs in the elderly. A secondary aim was to evaluate if timing of surgery affected outcomes. METHODS This cohort series evaluated 2-year outcomes for 42 patients with Neer 3- and 4-part PHFs treated with uncemented RSRs between October 2016 and December 2019. Thirty-eight patients (90%) had clinical and radiologic follow-up at a minimum of 2 years. The primary outcomes compared postoperative range of movement, radiographic outcomes, and patient-reported outcome measures (PROMs). The PROMs collected included Oxford Shoulder Scores (OSSs), satisfaction scores, and the Friends and Family Test. The secondary outcome involved a subanalysis to see if outcomes were affected by treatment timing-within 2 weeks, 2-12 weeks, and >12 weeks. RESULTS The mean age of patients was 74.1 years (range 58-89). There were 11 males and 31 females. No intraoperative fractures were sustained. There was 1 transient axillary neurapraxia, which fully resolved by 4 months. Three patients required postoperative transfusions. During the study follow-up period, no patients developed either deep infections requiring a washout or dislocation, and none underwent further surgery. At 2-year follow-up, radiologic follow-up demonstrated tuberosity union in 29 of 38 cases (76%). Eight of 38 patients (21%) demonstrated some glenoid notching (Sirveaux 1 or 2 only) on radiographic follow-up. There was no evidence of loosening. The mean OSS was 38 (range 15-48). Mean range of movement achieved at 2 years was as follows: forward flexion 122° (50°-180°), abduction 116° (46°-180°), and external rotation 25° (range 5°-60°). Eighteen patients (47%) described their result as excellent, 17 (45%) as good, and 3 (8%) as poor. When comparing the time from injury to treatment, there was no statistically significant difference in complications or radiographic outcomes between the groups. Patients had a reduced forward flexion when treated between 2 and 12 weeks compared with the other groups (P = .019). CONCLUSION Uncemented RSR is a safe treatment option for the management of complex PHFs in the elderly. We report low complication rates, high patient satisfaction, and good outcomes at 2-year follow-up.
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Affiliation(s)
- Salma Chaudhury
- Royal Berkshire Hospital, Reading, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | | | | | | | - Amar Malhas
- Royal Berkshire Hospital, Reading, United Kingdom.
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22
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Shivkumar S, Mehta V, Vaddamanu SK, Shetty UA, Alhamoudi FH, Alwadi MAM, Aldosari LIN, Alshadidi AAF, Minervini G. Surgical Protocols before and after COVID-19-A Narrative Review. Vaccines (Basel) 2023; 11:vaccines11020439. [PMID: 36851316 PMCID: PMC9963090 DOI: 10.3390/vaccines11020439] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
The COVID-19 epidemic has affected not only people's daily lives but also the working methods of clinicians, surgical procedures, open/minimally invasive procedures, operating room management, patient and healthcare worker safety, education and training. The main objective of this study was to review selected articles and determine the changes in the general surgery protocols/procedures before and after the emergence of the COVID-19 pandemic. The literature was carried out in PubMed-Medline, Cochrane Library, Embase, Scopus and Google Scholar. The terms utilised for the searches were "SARS-CoV-2", "Surgery", "COVID-19", "Surgical protocol", "Surgical recommendations" and "before and after". A total of 236 studies were identified, out of which 41 studies were included for data extraction. Significant changes in all the articles were observed with respect to the surgeries done before, during and after the COVID-19 pandemic. Specifically, the number of elective surgeries were considerably fewer in comparison to the pre-pandemic period. Since the COVID-19 pandemic started, hospitals all throughout the world have conducted significantly fewer procedures, particularly elective/non-urgent surgeries.
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Affiliation(s)
- Sahana Shivkumar
- Department of Public Health Dentistry, Peoples College of Dental Sciences & Research Centre, People University, Bhopal 462037, India
| | - Vini Mehta
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, India
- Correspondence:
| | - Sunil Kumar Vaddamanu
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Urvashi A. Shetty
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to Be University), Mangalore 575018, India
| | - Fahad Hussain Alhamoudi
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Maram Ali M. Alwadi
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | | | - Abdulkhaliq Ali F. Alshadidi
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical–Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Fabiani MA, González-González M, Cardenas-Figueroa EG, Rosero-Aguirre VA, Viteri-Pérez VH. High Altitude Carotid Body Tumors Growth During active Surveillance. Vasc Endovascular Surg 2023:15385744231154089. [PMID: 36683142 DOI: 10.1177/15385744231154089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The gold standard for patients with carotid body tumors (CBT) is surgical resection; nevertheless, some patients are unfit for surgery or, for other reasons, could not be operated on. Active surveillance has been known to be a reasonable strategy for these cases. This study aimed to evaluate tumor growth in unoperated patients with CBTs. METHODS A retrospective review of all unoperated patients with CBT from a single academic hospital diagnosed between 2014 and 2021 was performed. Results of nonparametric testing were presented using the median and ranges for Mann-Whitney-U or Kruskal-Wallis. Significance was defined as a 2-tailed P < .05. RESULTS The cohort included a total of 31 patients, with a median age of 60 years (range: 37-80 years), of which 27 (87.1%) were females. The patients live at a median altitude of 2800 meters (range: 2756-2980 meters) above sea level. Twenty (64.5%) patients had Shamblin I tumors, eight (25.8%) patients had Shamblin II tumors, and three (9.7%) patients had Shamblin III tumors. Median CBT volume at diagnosis was 14.1 cm3 (range: .9 - 213.3 cm3). Median volume at diagnosis of symptomatic tumors was substantially larger than asymptomatic tumors, 49.2 cm3 vs 7.9 cm3, respectively (P = .03). Median growth of the tumors during a median 15-month follow-up (range: 3-43 months) was 3.3 cm3 (range: 0-199.9 cm3). Overall, 77% (n = 24) of the CBTs grew at least 1 cm3. CONCLUSION Most patients in the present study had tumor growth by at least 1 cm3, with a median tumor growth of 3.3 cm.3 In the present study tumor growth was shown to be greater than other low altitude CBT active surveillance studies; therefore, surgical resection should be recommended in patients with CBT living at high altitudes.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - David E Hinojosa-Gonzalez
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - Mario Alejandro Fabiani
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - Mirna González-González
- 27746Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
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Curfman KR, Blair GE, Pille SA, Kosnik CL, Rashidi L. The patient perspective of same day discharge colectomy: one hundred patients surveyed on their experience following colon surgery. Surg Endosc 2023; 37:134-139. [PMID: 35854124 PMCID: PMC9296012 DOI: 10.1007/s00464-022-09446-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Guided by enhanced recovery after surgery protocols and coerced by constraints of the Coronavirus Disease 2019, the concept of same day discharge (SDD) after colon surgery is becoming a topic of great interest. Although only a few literature sources are published on the topic and protocols, the number of centers interested in SDD is increasing. With the small number of sources on protocol, safety, implementation, and criteria, there has yet to be a review of the patient experience and satisfaction. METHODS Our institution has one of the largest American databases of SDD colon surgery. We performed a retrospective patient survey assessing perception of their surgical experience and satisfaction, which analyzed patients from February 2019 to January 2022. Fifty SDD patients were selected for participation, as well as fifty patients who were discharged on postoperative day 1 (POD1). An eleven-question survey was offered to patients and responses recorded. RESULTS One hundred patients were contacted, 50 SDD and 50 POD1. Of the SDD patients, 41/50 (82%) patients participated in the survey, while 23/50 (46%) of POD1 patients participated. The highest average response in both populations was an understanding of patient postoperative mobility instructions (9.27/10, 9.68/10). The lowest average response in the SDD population was family comfort with discharge (8.17/10), while patient comfort with discharge was lowest in the POD1 group, (8.56/10). Importantly, we observed that 85.37% of patients who underwent SDD would do so again if given the opportunity. The only statistically significant variable was a difference in comfort with postoperative pain control, favoring the POD1 group, p = 0.02. CONCLUSIONS SDD colon surgery is a feasible and reproducible option. Only comfort with postoperative pain control found a statistical difference, which we intend to improve upon with postanesthesia care unit education. Of patients reviewed who underwent SDD, most patients enjoyed their experience and would undergo SDD again.
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Chrysos A, Amygdalos I, Nunes P, Haselow G, Lioupis K, Rosch R, Eickhoff RM, Wiltberger G, Neumann UP, Lambertz A. The impact of the COVID-19 outbreak on emergency general surgery in the first German "hotspot region" Aachen-Heinsberg-A multicentre retrospective cohort study. PLoS One 2023; 18:e0280867. [PMID: 36696422 PMCID: PMC9876361 DOI: 10.1371/journal.pone.0280867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
This study aimed to observe the impact of the COVID-19 outbreak on acute general surgery in the first German "hotspot" regions of Heinsberg and Aachen, during the first months of the pandemic. The incidence and severity of acute appendicitis, acute cholecystitis and mechanical bowel obstruction, were compared between March and May 2020 and a control period (same months of the previous three years). Pre-, intra- and postoperative data was compared between three regional hospitals of Heinsberg and the closest maximum care, university hospital. A total of 592 operated patients were included, 141 belonging to the pandemic cohort and 451 to the historic cohort. The pandemic group showed higher rates of clinical peritonitis (38% vs. 27%, p = 0.015), higher rates of mean white blood cell count (13.2±4.4 /nl vs. 12.3±4.7 /nl, p = 0.044) and mean C-reactive protein (60.3±81.1 mg/l vs. 44.4±72.6 mg/l, p = 0.015) preoperatively. Specifically in patients with acute appendicitis, there were less patients with catarrhal appendicitis (23% vs. 35%, p = 0.021) and a tendency towards more advanced histological findings in the pandemic cohort. In the university hospital, a 42% reduction in acute operated cases was observed at the onset of the pandemic (n = 30 in 2020 vs. n = 52 in 2019), whereas in the peripheral hospitals of Heinsberg there was only a 10% reduction (n = 111 in 2020 vs. n = 123 in 2019). The onset of the COVID-19 pandemic in our region was accompanied by advanced preoperative and intraoperative findings in patients undergoing emergency general surgery. A greater reduction in acute operated surgical cases was observed at the university hospital, in contrast to the smaller hospitals of Heinsberg, suggesting a possible shift of emergency patients, requiring immediate operation, from maximum care hospital to the periphery.
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Affiliation(s)
- Alexandros Chrysos
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
- * E-mail:
| | - Iakovos Amygdalos
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Priscila Nunes
- Department of General Surgery, St. Elisabeth-Hospital, Geilenkirchen, Nordrhein-Westfalen, Germany
| | - Guenter Haselow
- Department of General Surgery, St. Elisabeth-Hospital, Geilenkirchen, Nordrhein-Westfalen, Germany
| | - Konstantinos Lioupis
- Department of General Surgery, Municipal Hospital, Heinsberg, Nordrhein-Westfalen, Germany
| | - Raphael Rosch
- Department of General Surgery, Hermann-Josef-Hospital, Erkelenz, Nordrhein-Westfalen, Germany
| | - Roman Marius Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Georg Wiltberger
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
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Montauban P, Balakumar C, Rait J, Zarsadias P, Shahzad F, Ogbuagu N, Iqbal S, Chowdhury A, Pangeni A, Shah A, Imtiaz MR. Impact of the COVID-19 pandemic on the management and outcomes of emergency surgical patients: A retrospective cohort study. J Perioper Pract 2023; 33:37-47. [PMID: 35322695 PMCID: PMC9827141 DOI: 10.1177/17504589211032625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has led to drastic measures being implemented for the management of surgical patients across all health services worldwide, including the National Health Service in the United Kingdom. It is suspected that the virus has had a detrimental effect on perioperative morbidity and mortality. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on these outcomes in emergency general surgical patients. METHODS Emergency general surgical admissions were included in this retrospective cohort study in one of the COVID-19 hotspots in the South East of England. The primary outcome was the 30-day mortality rate. Secondary outcomes included the length of stay in hospital, complication rate and severity grade and admission rates to the ITU. RESULTS Of 123 patients, COVID-19 was detected in 12.2%. Testing was not carried out in 26%. When comparing COVID-positive to COVID-negative patients, the mean age was 71.8 + 8.8 vs. 50.7 + 5.7, respectively, and female patients accounted for 40.0 vs. 52.6%. The 30-day mortality rate was 26.7 vs. 3.9 (OR 6.49, p = 0.02), respectively. The length of stay in hospital was 20.5 + 22.2 vs. 7.7 + 9.8 (p < 0.01), the rate of complications was 80.0 vs. 23.7 (OR 12.9, p < 0.01), and the rate of admission to the ITU was 33.3 vs. 7.9% (OR 5.83, p = 0.01). CONCLUSION This study demonstrates the detrimental effect of COVID-19 on emergency general surgery, with significantly worsened surgical outcomes.
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Affiliation(s)
- Pierre Montauban
- Pierre Montauban, Department of General
Surgery, William Harvey Hospital, East Kent Hospitals University NHS Foundation
Trust, Ashford, Kent TN24 0LZ, UK.
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27
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Yiğit H, Demir ZA, Balcı E, Mavioğlu LH. Non-interventional Feasibility Assessment for Fast-Track Cardiac Anesthesia. Cureus 2023; 15:e34392. [PMID: 36874645 PMCID: PMC9976947 DOI: 10.7759/cureus.34392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/31/2023] Open
Abstract
Background The introduction of fast-track extubation procedures following cardiac surgery has significantly shortened hospitalization duration in intensive care units (ICUs). Early extubation is the most crucial step in getting out of the ICU early and providing ideal patient circulation. In times of crisis such as pandemics, it is vital to provide rapid flow through the hospital to prevent the postponement or inability to operate on patients awaiting surgery. This study aimed to determine the obstacles to early extubation in patients undergoing cardiac surgery and the perioperative characteristics that were affected in terms of fast-track extubation. Methodology This was an observational, cross-sectional study with data collected prospectively from October 1 to November 30, 2021. Preoperative data and comorbidities were recorded. Intraoperative and postoperative data were recorded and analyzed. Intraoperative cross-clamp duration, cardiopulmonary bypass duration, length of operation, and erythrocytes (red blood cells) transfused were recorded for each patient. Early postoperative clinical conditions were defined in patients whose mechanical ventilation duration exceeded eight hours (such as pulmonary complications, cardiovascular complications, renal complications, neurological conditions, and infective complications ). The length of ICU stay (hours), length of hospital stay (days), return to the ICU, reasons for return to the ICU, and overall hospital mortality were investigated. A total of 226 patients were included in the study. Patients were divided into two groups: extubated within eight hours (FTCA, fast-track cardiac anesthesia) and late extubation (after eight hours) postoperatively, and the data were evaluated accordingly. Results While 138 (61.1%) of the patients were extubated in eight hours or less, 88 (38.9%) patients were extubated after more than eight hours. The most common complications (55.7%) in patients with late extubation were cardiovascular complications, followed by respiratory complications (15.9%), and the surgeon's refusal (15.9%). In the logistic model created with the independent variables affecting the extubation time, the American Society of Anesthesiologists score and red blood cell transfusion were risk factors for longer extubation time. Conclusions In our research to reveal the feasibility of and barriers to FTCA, it was found that cardiac and respiratory problems were the most common reasons for delayed extubation. Due to the refusal of the surgical team, it was observed that some patients remained intubated despite meeting the FTCA requirements. It was considered the most improvable obstacle. Regarding cardiovascular complications, the team should aim to optimally control patient comorbidities in the preoperative period, reduce the use of red blood cell transfusions, and ensure that the entire team is updated on current extubation protocols, in particular surgeons and anesthesiologists.
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Affiliation(s)
- Hülya Yiğit
- Anesthesiology, Ankara City Hospital, Ankara, TUR
| | | | - Eda Balcı
- Anesthesiology, Ankara City Hospital, Ankara, TUR
| | - Levent H Mavioğlu
- Cardiac/Thoracic/Vascular Surgery, Ankara City Hospital, Ankara, TUR
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Crawford AM, Lightsey Iv HM, Xiong GX, Ye J, Call CM, Pomer A, Cooper Z, Simpson AK, Koehlmoos TP, Weissman JS, Schoenfeld AJ. Changes in Elective and Urgent Surgery Among TRICARE Beneficiaries During the COVID-19 Pandemic. Mil Med 2022; 188:usac391. [PMID: 36519498 DOI: 10.1093/milmed/usac391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND COVID-19 is known to have altered the capacity to perform surgical procedures in numerous health care settings. The impact of this change within the direct and private-sector settings of the Military Health System has not been effectively explored, particularly as it pertains to disparities in surgical access and shifting of services between sectors. We sought to characterize how the COVID-19 pandemic influenced access to care for surgical procedures within the direct and private-sector settings of the Military Health System. METHODS We retrospectively evaluated claims for patients receiving urgent and elective surgical procedures in March-September 2017, 2019, and 2020. The pre-COVID period consisted of 2017 and 2019 and was compared to 2020. We adjusted for sociodemographic characteristics, medical comorbidities, and region of care using multivariable Poisson regression. Subanalyses considered the impact of race and sponsor rank as a proxy for socioeconomic status. RESULTS During the period of the COVID-19 pandemic, there was no significant difference in the adjusted rate of urgent surgical procedures in direct (risk ratio, 1.00; 95% CI, 0.97-1.03) or private-sector (risk ratio, 0.99; 95% CI, 0.97-1.02) care. This was also true for elective surgeries in both settings. No significant disparities were identified in any of the racial subgroups or proxies for socioeconomic status we considered in direct or private-sector care. CONCLUSIONS We found a similar performance of elective and urgent surgeries in both the private sector and direct care during the first 6 months of the COVID-19 pandemic. Importantly, no racial disparities were identified in either care setting.
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Affiliation(s)
- Alexander M Crawford
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Harry M Lightsey Iv
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Grace X Xiong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jamie Ye
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Alysa Pomer
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew J Schoenfeld
- Center for Surgery and Public Health, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Li J, Jiao W, Yuan H, Feng W, Ding X, Yin X, Zhang L, Lv W, Ma L, Sun L, Feng R, Qin J, Zhang X, Gou C, Wang S, Yu Z, Wei B, Luo L, Xie F, Chang Y, Wang Y, Giulianotti PC, Dong Q, Niu H. Telerobot-assisted laparoscopic adrenalectomy: feasibility study. Br J Surg 2022; 110:6-9. [PMID: 35997257 DOI: 10.1093/bjs/znac279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Jianmin Li
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Wei Jiao
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hang Yuan
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Feng
- Department of Anaesthesiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuemei Ding
- Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xulong Yin
- Department of Urology, Pingyi County Hospital of Traditional Chinese Medicine, Linyi, China
| | - Liangjun Zhang
- Department of Surgery, Zhucheng Hospital of Traditional Chinese Medicine, Zhucheng, China
| | - Wei Lv
- Department of Urology, Fei County People's Hospital, Linyi, China
| | - Lufei Ma
- Department of Urology, Juxian People's Hospital, Rizhao, China
| | - Liguo Sun
- Department of Urology, Juxian People's Hospital, Rizhao, China
| | - Run Feng
- Department of Urology, Zibo Municipal Hospital, Zibo, China
| | - Jun Qin
- Department of Urology, Yinan People's Hospital, Linyi, China
| | - Xuefeng Zhang
- Department of Urology, Weihai Central Hospital, Weihai, China
| | - Chengyi Gou
- Department of Urology, Dingxi People's Hospital, Dingxi, China
| | - Shuxin Wang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Zongyi Yu
- Department of Information Management, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Wei
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Luo
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fei Xie
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Chang
- Shandong Development and Reform Commission, Jinan, China
| | - Yonghua Wang
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Pier C Giulianotti
- Department of Surgery, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Qian Dong
- Department of Paediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haitao Niu
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
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Seretis K, Bounas N, Gaitanis G, Bassukas I. A Meta-Analysis on the Impact of the COVID-19 Pandemic on Cutaneous Melanoma Diagnosis in Europe. Cancers (Basel) 2022; 14:cancers14246085. [PMID: 36551570 PMCID: PMC9776971 DOI: 10.3390/cancers14246085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has been the epicenter of healthcare attention globally for the past two years, and large-scale adaptations in healthcare provision have been required. This study aimed to investigate the impact of the pandemic and the resulting lockdowns on cutaneous melanoma diagnosis and tumor burdens in Europe. A relevant literature search in electronic databases was conducted from inception to September 2022. The inclusion criteria were: controlled studies published in a peer-reviewed journal evaluating cutaneous melanoma in Europe and reporting data on melanoma characteristics from diagnoses. The quality of studies was evaluated using the Cochrane ROBINS-I tool for assessing bias in non-randomized studies. Meta-analysis was conducted utilizing a random effects model to synthesize the data. A total of 25 studies involving 32,231 patients were included in the data analysis models. Statistically significant increases in mean Breslow thickness (0.29 mm (0.03-0.55 mm)), ulceration rates (OR = 1.66 (1.29-2.13)), and resultant tumor staging were observed in the PostCovid group, with subgroup analysis revealing that lockdown-derived data were responsible for this trend. This meta-analysis reported on the impact of COVID-19 restrictions on melanoma diagnosis in Europe, emphasizing the higher tumor burden and disease progression state provoked by healthcare adaptations in the pandemic period.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
- Correspondence: (K.S.); (I.B.); Tel.: +30-26-5109-9077 (K.S.); +30-26-5100-7425 (I.B.)
| | - Nikolaos Bounas
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Ioannis Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
- Correspondence: (K.S.); (I.B.); Tel.: +30-26-5109-9077 (K.S.); +30-26-5100-7425 (I.B.)
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de Bock E, Herman ES, Bastian OW, Filipe MD, Vriens MR, Richir MC. Systematic review and meta-analysis determining the effect of implemented COVID-19 guidelines on surgical oncology volumes and clinical outcomes. Surg Oncol 2022; 45:101859. [PMID: 36242979 PMCID: PMC9529677 DOI: 10.1016/j.suronc.2022.101859] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND To provide for Coronavirus Disease 2019 (COVID-19) healthcare capacity, (surgical oncology) guidelines were established, forcing to alter the timing of performing surgical procedures. It is essential to determine whether these guidelines have led to disease progression. This study aims to give an insight into the number of surgical oncology procedures performed during the pandemic and provide information on short-term clinical outcomes. MATERIALS AND METHODS A systematic literature search was performed on all COVID-19 articles including operated patients, published before March 21, 2022. Meta-analysis was performed to visualize the number of performed surgical oncology procedures during the pandemic compared to the pre-pandemic period. Random effects models were used for evaluating short-term clinical outcomes. RESULTS Twenty-four studies containing 6762 patients who underwent a surgical oncology procedure during the pandemic were included. The number of performed surgical procedures for an oncological pathology decreased (-26.4%) during the pandemic. The number of performed surgical procedures for breast cancer remained stable (+0.3%). Moreover, no difference was identified in the number of ≥T2 (OR 1.00, P = 0.989), ≥T3 (OR 0.95, P = 0.778), ≥N1 (OR 1.01, P = 0.964) and major postoperative complications (OR 1.55, P = 0.134) during the pandemic. CONCLUSION The number of performed surgical oncology procedures during the COVID-19 pandemic decreased. In addition, the number of performed surgical breast cancer procedures remained stable. Oncological staging and major postoperative complications showed no significant difference compared to pre-pandemic practice. During future pandemics, the performed surgical oncology practice during the first wave of the COVID-19 pandemic seems appropriate for short-term results.
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Affiliation(s)
- Ellen de Bock
- Corresponding author. PO Box 85500, 3508, GA, Utrecht, the Netherlands
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Aslani H, Bonakdar S, Gorji M, Gholipour M. Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction. Adv Biomed Res 2022; 11:102. [PMID: 36660760 PMCID: PMC9843597 DOI: 10.4103/abr.abr_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/07/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023] Open
Abstract
Background As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2nd, 6th, and 12th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.
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Affiliation(s)
- Hamidreza Aslani
- Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran
| | - Sona Bonakdar
- Skin Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Gorji
- Skin Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Gholipour
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,Address for correspondence: Dr. Morteza Gholipour, Clinical Research Development Unit, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
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Curfman KR, Poola AS, Blair GE, Kosnik CL, Pille SA, Hawkins ME, Rashidi L. Ambulatory colectomy: a pathway for advancing the enhanced recovery protocol. J Robot Surg 2022. [PMID: 36334255 DOI: 10.1007/s11701-022-01463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols employ multiple factors to decrease surgical stress and improve recovery (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012). These protocols use multimodal approaches to improve outcomes, including length of stay and morbidities (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012; Carmichael et al., Dis Colon Rectum 60:761-784, 2017). The ERAS guidelines have evolved since development; however, the question is posed of how to improve next (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012). With the success of ERAS, in combination with milestones made by minimally invasive surgery (MIS), it is our aim to describe the next step of same day discharge colectomy. Retrospective review was performed on all colectomies from February 2019 to January 2022. Same day discharge (SDD) was defined as admission less than 23 h and no overnight stay. Procedures were nonemergent and MIS. Patients were candidates SDD based on comorbidities, communication means, and social support. SDD candidacy continued if surgery was uncomplicated. Next, patients were required to achieve strict Post Anesthesia Care Unit (PACU) criteria for discharge. SDD patients were monitored via calls or messages until their first appointment. After analysis, 326 total colectomies were identified; based on inclusion and exclusion criteria, 115 patients underwent SDD, 35.3%. Of the 115 SDD, 5 patients returned to the emergency department, only 1 required readmission (0.9%). The most performed procedures were low anterior resection, 61 (53.0%), and right hemicolectomy, 25 (21.7%). Using ERAS protocols as a groundwork to improve upon, we identified several ways to advance select patients into SDD. Using strict patient selection, intraoperative regulations, and rigorous postoperative criteria, we found that SDD as an advancement of ERAS is a relatively safe procedure with minimal complications.
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Demissie WR, Mulatu B, Siraj A, Hajikassim A, Kejela E, Muluken Z, Mekonin GT, Biratu M, Birhanu M, Dadi N, Kelbesa M, Belay A, Dukessa A. Pattern of Perioperative Surgical Patient Care, Equipment Handling and Operating Room Management During COVID-19 Pandemic at Jimma Medical Center. J Multidiscip Healthc 2022; 15:2527-2537. [PMID: 36352855 PMCID: PMC9639398 DOI: 10.2147/jmdh.s372428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The nature of COVID-19 transmission creates significant risks in surgical departments owing to the close contact of medical staff with patients, the limited physical environment of the operating room and recovery room, the possibility of shared surgical equipment and challenges in the delivery of surgical care in all surgical departments. Globally, studies have reported that the effects of the pandemic on surgical departments are profound, potentially long-lasting and extensive. To manage these effects, different local guidelines and recommendations have been developed, with potential differences in their effectiveness and implementation. Therefore, harmonized and effective national/international guidelines for specific surgical departments during perioperative periods are pertinent to curtail the infection, and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The pattern of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC), Ethiopia, has not been explored yet. The present study aimed to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC. METHODS A cross-sectional study was conducted to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC, using five-point Likert scales (0, not at all; 1, rarely; 2, sometimes; 3, most of the time; 4, frequently). A total of 90 respondents [35 patients (five patients from each of seven surgical departments) and 55 healthcare providers (six professionals from each of nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by a convenience sampling technique with multistage clustering, participated in the study. Data were collected using a structured questionnaire via direct observation and face-to-face interviews with patients undergoing surgery, healthcare providers and hospital administrators, against the standard surgical patient care guidelines. The collected data were manually checked for missing values and outliers, cleared, entered into EpiData (v4.3.1) and exported to SPSS (v22) for analysis. The mean score of practice was compared among different disciplines by applying the unpaired t-test. The findings of the study were reported using tables and narration. A p-value of less than 0.05 was declared as statistically significant. RESULTS Despite the surgical care practice having changed during the COVID-19 pandemic in all service domains, it is not implemented consistently among different surgical departments owing to different barriers (lack of training on the updated guidelines and financial constraints). The majority of surgical staff were implementing the use of preventive measures against COVID-19, while they were practiced less among patients. The guidelines for surgical practice during the preoperative phase were well applied, especially screening patients by different methods and the application of telemedicine to reduce physical contacts. But, against guidelines, elective patients were planned and underwent surgery, especially in the general surgery department. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. The extent of practice for anesthesia care, operating room management and postoperative care in the recovery room also changed, and the guidelines were sometimes applied. CONCLUSION AND RECOMMENDATIONS Although perioperative surgical care practice differed before and during the pandemic, the standard guidelines were inconsistently implemented among surgical departments. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. Thus, the authors developed safe surgical care guidelines throughout the different domains (infection prevention and PPE use; preoperative care, intraoperative care, operating room management, anesthesia care, equipment handling process and postoperative care) for all disciplines and shared them with all staff. We recommend that all surgical staff should access these guidelines and strictly adhere to them for surgical service during the pandemic.
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Affiliation(s)
- Wondu Reta Demissie
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia, Ethiopia,Correspondence: Wondu Reta Demissie, Jimma University, Jimma, Oromia, Ethiopia, Email ;
| | - Bilisuma Mulatu
- School of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Ahmed Siraj
- School of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Edosa Kejela
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Zemenu Muluken
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Melka Biratu
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Mitiku Birhanu
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Negashu Dadi
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Megersa Kelbesa
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Admasu Belay
- School of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | - Abebe Dukessa
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia, Ethiopia
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Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) has significantly impacted healthcare delivery and utilization. The aim of this article was to assess the impact of the COVID-19 pandemic on in-hospital continuous electroencephalography (cEEG) utilization and identify areas for process improvement. METHODS A 38-question web-based survey was distributed to site principal investigators of the Critical Care EEG Monitoring Research Consortium, and institutional contacts for the Neurodiagnostic Credentialing and Accreditation Board. The survey addressed the following aspects of cEEG utilization: (1) general center characteristics, (2) cEEG utilization and review, (3) staffing and workflow, and (4) health impact on EEG technologists. RESULTS The survey was open from June 12, 2020 to June 30, 2020 and distributed to 174 centers with 79 responses (45.4%). Forty centers were located in COVID-19 hotspots. Fifty-seven centers (72.1%) reported cEEG volume reduction. Centers in the Northeast were most likely to report cEEG volume reduction (odds ratio [OR] 7.19 [1.53-33.83]; P = 0.012). Additionally, centers reporting decrease in outside hospital transfers reported cEEG volume reduction; OR 21.67 [4.57-102.81]; P ≤ 0.0001. Twenty-six centers (32.91%) reported reduction in EEG technologist coverage. Eighteen centers had personal protective equipment shortages for EEG technologists. Technologists at these centers were more likely to quarantine for suspected or confirmed COVID-19; OR 3.14 [1.01-9.63]; P = 0.058. CONCLUSIONS There has been a widespread reduction in cEEG volume during the pandemic. Given the anticipated duration of the pandemic and the importance of cEEG in managing hospitalized patients, methods to optimize use need to be prioritized to provide optimal care. Because the survey provides a cross-sectional assessment, follow-up studies can determine the long-term impact of the pandemic on cEEG utilization.
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Affiliation(s)
- Sahar F. Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Emily J. Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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Massarra C, Rahat MHH, Wang G, Sadek H. Evaluating the cost of collection, processing, and application of face masks in hot-mix asphalt (HMA) pavements. Heliyon 2022; 8:e11239. [DOI: 10.1016/j.heliyon.2022.e11239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 10/31/2022] Open
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Cintean R, Eickhoff A, Nussbaum K, Gebhard F, Schuetze K. No Excess Mortality in Geriatric Patients With Femoral Neck Fractures Due to Shorter Intensive Care Caused by COVID-19. Cureus 2022; 14:e29986. [PMID: 36381761 PMCID: PMC9636867 DOI: 10.7759/cureus.29986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background Since March 2020, increasing numbers of hospitalized patients with coronavirus disease-2019 (COVID-19) infections have been registered. The first and the second waves necessitated the extensive restructuring of hospital infrastructure with prioritization of intensive care capacity. Elective surgeries in all surgical disciplines were postponed to preserve intensive care capacity for COVID-19 patients. However, emergency care for trauma patients had to be maintained. Especially, geriatric patients with hip fractures often require intensive care. This study sought to investigate the possible excess mortality of geriatric patients with femoral neck fractures due to shorter intensive care unit stays because of COVID-19. Material and methods All patients over the age of 70 between March 2019 and February 2020 who underwent surgical treatment for femoral neck fractures were included. This cohort (group 1) was compared with all patients over 70 who received surgical treatment for hip fractures during the period of the pandemic between March 2020 and February 2021 with attention to potential excess mortality due to low intensive care capacity (group 2). Demographic data, American Society of Anesthesiologists (ASA) score, surgical modality, ICU stay, complications, and mortality were analyzed and compared. Results A total of 356 patients with 178 in each cohort with a mean age of 82.7 in group 1 and 84.8 in group 2 (p<0.05) were included. No significant difference was seen in sex and ASA scores. During the pandemic, patients with hip fractures had a significantly shorter stay in ICU (0.4 ± 0.9 vs 1.2 ± 2.8 days; p<0.05), shorter time to surgery (29.9 ± 8.2 vs 16.8 ± 5.3 h; p<0.05) and operations were significantly more often performed out-of-hour (4 pm-12 am 47.8% vs 56.7%; 12 am-8 am 7.9% vs 13.5%, p<0.05). Interestingly, mortality was lower during the pandemic, but the difference did not reach significance (6.7% vs 12.4%, p=0.102). Conclusion During the pandemic, ICU capacity was reserved for COVID patients. Due to a change in the law of the Joint Federal Committee with effect from January 1, 2021, all patients with proximal femur fractures had to be operated on within the first 24 hours, which is why a significantly shorter time to surgery was observed during the pandemic period. As a consequence, a lower mortality rate was observed, although no significance could be reached.
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Sulaiman A, Lim CY, Brussius Coelho M, Hayward P, Nicklin S, Gianoutsos M. Effects of COVID-19 lockdown on emergency paediatric plastic surgery admissions. Australas J Plast Surg 2022. [DOI: 10.34239/ajops.v5n2.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: On 23rd March 2020, Australia went into a nationwide lockdown that led to school closures. As a result, children spent more time at home, increasing their vulnerability to injuries sustained at home. This study aims to analyse the patterns of emergency paediatric plastic surgery admissions into a tertiary paediatric hospital in Sydney during the COVID-19 lockdown period, and to raise awareness on the impacts of lockdown measures on the vulnerable pediatric population.
Methods: A retrospective analysis was conducted at a tertiary paediatric hospital in Sydney. Admissions into the Plastic and Reconstructive Surgery department during the lockdown period of 23rd March to 15th May 2020, and the same period in 2019 were included in the analysis. Ethics approval for the study was obtained from the Sydney Children’s Hospitals Network Human Research Ethics Committee [HREC Reference 2021/ETH00451]
Results: There were 37 and 91 admissions in 2020 and 2019 respectively. The proportion of injuries sustained at home increased by 24% in 2020, consistent with increased time spent at home. The percentage of injuries due to animal bites and sharp objects increased while number of sports-related injuries and falls decreased during the lockdown. Motor vehicle accidents increased in 2020. More patients also opted for conservative management in 2020.
Conclusion: This study has shown that during a pandemic lockdown, home injuries are more common, children are less likely to present to hospital and more likely to opt for conservative management. With a greater understanding of patterns of paediatric injuries during lockdowns, the relevant authorities can develop targeted advisories for dissemination to the public on how to create a safe home environment for children.
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Ahmad MS, Sadien I, Ivanov B. Changes in the Emergency General Surgery Operations in the Setting of COVID-19 and Impact of Strategy of Non-Operative Management on Outcomes in Acute Appendicitis. Cureus 2022; 14:e27552. [PMID: 36059372 PMCID: PMC9428940 DOI: 10.7759/cureus.27552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has posed significant challenges to the provision of elective and emergency general surgical care. Patterns of presentation have changed and management pathways have also been adapted, moving to more non-operative management (NOM) for some conditions. We investigated how COVID-19 changed the volume of emergency general surgery operating in our district general hospital (DGH). We aimed to evaluate the impact of NOM on outcomes in acute appendicitis. Methods: A retrospective case review of operating lists, patient handover lists, and patient notes was undertaken for patients presented between 1st January 2020 and 3rd June 2020. The study period was divided into two, with the period between 1st January 2020 and 23rd March 2020 representing the pre-COVID cohort. Results: Some 393 emergency general surgery operations were performed in the study period. There was a clear reduction in operating volume after 23rd March 2020. During that same period, 325 patients were assessed with right iliac fossa (RIF) pain. Median age was 21 (range 5-87) and 201 patients were female (61.8%). The rate of NOM for suspected acute appendicitis was 8.8% in the pre-COVID group, which increased to 36.4% in the COVID group. The incidence of normal histology following appendicectomy did not change with this difference in management (16.1% compared to 17.9%, p = 0.78). Conclusions: This study summarizes the changes brought to the provision of emergency general surgery in the setting of a DGH by the COVID-19 pandemic. In particular, NOM was the preferred option for acute appendicitis but this did not alter the negative appendicectomy rate.
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de Bock E, Filipe MD, Simmermacher RKJ, Kroese AC, Vriens MR, Richir MC. Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients. BMJ Open 2022; 12:e058389. [PMID: 35798523 PMCID: PMC9263349 DOI: 10.1136/bmjopen-2021-058389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Patients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients. DESIGN Systematic review and meta-analysis. DATA SOURCES Pubmed and Embase databases were searched through 20 February 2022. ELIGIBILITY CRITERIA All COVID-19 articles including preoperative asymptomatic patients were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients. RESULTS Twenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%. CONCLUSIONS The pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | | | - A Christiaan Kroese
- Department of Anaesthesiology, University Medical Centre, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
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Ower C, Stock K, Kaiser P, Ulmer H, Arora R, Haselbacher M. Variation in patterns and volumes of injuries admitted to a level one trauma center during lockdown for COVID-19. J Orthop Surg Res 2022; 17:306. [PMID: 35690778 PMCID: PMC9188017 DOI: 10.1186/s13018-022-03151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Due to the global COVID-19 pandemic, a ban on sports outside one’s home and a prohibition on travel between communities were imposed in spring 2020 in Tyrol, Austria. The aim of this study was to evaluate the impact of these restrictions on a level one trauma center. The objective was to identify the most common injury patterns to ensure targeted prevention in times of an ongoing pandemic. Material and methods Patients who presented themselves to our trauma center between weeks 7 and 22 in 2020 were retrospectively compared to a mean of the patients of the three previous years (2017–2019). The evaluated variables were the number of patients, age, gender, country of residence, place of accident, time of treatment, injured body region and anatomical structure, number of surgical intervention and severely injured patients. Results Comparing the mean count of treated patients per week in 2020 of the pre-lockdown period (n = 804.6) with the lockdown period (n = 201.8) a decrease in admissions by 69.7% could be observed. The admission incidence was 9.9 times higher in previous years than in 2020 during the lockdown period. Among the injuries treated during the lockdown the largest increase in relative numbers was in home injuries, head or face injuries and superficial or penetrating injuries. There was a decrease of seriously injured patients as well as patients that needed surgery during the lockdown compared to previous years. Conclusions We observed a significant change in the pattern and volume of injuries during a strict lockdown. Intervention programs to reduce the risk of home injuries should be introduced. Furthermore, in order to save resources during a pandemic, specific guidelines on patient management and treatment should be established for the respective medical specialties. Trial registration: 1157/2020, 10.12.2020.
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Affiliation(s)
- Cornelia Ower
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Kerstin Stock
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Kaiser
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Goddard KS, Schulz J, Nzuki I, Hall JP. Examining the Impacts of the Coronavirus Pandemic and Social Distancing on the Health of People With Mobility Disabilities. Front Public Health 2022; 10:875880. [PMID: 35570911 PMCID: PMC9092371 DOI: 10.3389/fpubh.2022.875880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the effects of the coronavirus pandemic on the health and participation of people with mobility disabilities living in the community. Methods Participants responded to a survey designed to assess the effects of the coronavirus pandemic on their health and access to health care. Participants identified if various life situations were worsened, unchanged, or improved during the pandemic. Participants could provide further information on their improved or worsened lived experience in open-ended questions. Results A total of 39 people with mobility disabilities responded to the survey. Results indicate that many experienced a worsening of life situations related to health, including access to medications, health care services, and transportation. Conclusions Results show that many experiences were caused by the lack of appropriate policies, rather than the pandemic itself. Therefore, there is a need to modify pandemic preparedness plans and other policies to meet the needs of people with disabilities.
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Affiliation(s)
- Kelsey Shinnick Goddard
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States
| | - Jonathan Schulz
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States.,Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Isaac Nzuki
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States
| | - Jean P Hall
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States
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Jack K, Evans C, Bramley L, Cooper J, Keane T, Cope M, Hendron E. Identifying and Understanding the Non-Clinical Impacts of Delayed or Cancelled Surgery in Order to Inform Prioritisation Processes: A Scoping Review. Int J Environ Res Public Health 2022; 19:ijerph19095542. [PMID: 35564937 PMCID: PMC9103788 DOI: 10.3390/ijerph19095542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
The COVID-19 pandemic has resulted in significant delays to non-urgent elective surgery. Decision making regarding prioritisation for surgery is currently informed primarily by clinical urgency. The ways in which decision making should also consider potential social and economic harm arising from surgical delay are currently unclear. This scoping review aimed to identify evidence related to (i) the nature and prevalence of social and economic harm experienced by patients associated with delayed surgery, and (ii) any patient assessment tools that could measure the extent of, or predict, such social and economic harm. A rapid scoping review was undertaken following JBI methodological guidance. The following databases were searched in October 2020: AMED; BNI; CINAHL; EMBASE; EMCARE; HMIC; Medline; PsychINFO, Cochrane, and the JBI. A total of 21 publications were included. The findings were categorised into five themes: (i) employment, (ii) social function and leisure, (iii) finances, (iv) patients’ experiences of waiting, and (v) assessment tools that could inform decision making. The findings suggest that, for some patients, waiting for surgery can include significant social, economic, and emotional hardship. Few validated assessment tools exist. There is an urgent need for more research on patients’ experiences of surgical delay in order to inform a more holistic process of prioritising people on surgical waiting lists in the COVID-19 pandemic recovery stages.
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Affiliation(s)
- Kathryn Jack
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
- Correspondence:
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottinghamshire NG7 2RD, UK;
| | - Louise Bramley
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Joanne Cooper
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Tracy Keane
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Marie Cope
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
| | - Elizabeth Hendron
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottinghamshire NG5 1PB, UK; (L.B.); (J.C.); (T.K.); (M.C.); (E.H.)
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Curfman KR, Poola AS, Blair GE, Kosnik CL, Pille SA, Thilo EL, Hawkins ME, Rashidi L. Ambulatory colectomy: A pilot protocol for same day discharge in minimally invasive colorectal surgery. Am J Surg 2022. [DOI: 10.1016/j.amjsurg.2022.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022]
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45
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Javed AA, Habib JR, Kinny-Köster B, Hodgin M, Parish L, Cunningham D, Hacker-Prietz A, Burkhart RA, Burns WR, Shubert CR, Cameron JL, Zaheer A, Chu LCH, Kawamoto S, Thompson ED, Shin EJ, Narang A, Zheng L, Laheru DA, Hruban RH, He J, Wolfgang CL, Fishman EK, Lafaro K. The Impact of the COVID-19 Pandemic on Multidisciplinary Clinics: A High-Volume Pancreatic Cancer Center Experience. Curr Probl Diagn Radiol 2022; 51:675-679. [PMID: 35750529 PMCID: PMC9131444 DOI: 10.1067/j.cpradiol.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
The unprecedented impact of the Sars-CoV-2 pandemic (COVID-19) has strained the healthcare system worldwide. The impact is even more profound on diseases requiring timely complex multidisciplinary care such as pancreatic cancer. Multidisciplinary care teams have been affected significantly in multiple ways as healthcare teams collectively acclimate to significant space limitations and shortages of personnel and supplies. As a result, many patients are now receiving suboptimal remote imaging for diagnosis, staging, and surgical planning for pancreatic cancer. In addition, the lack of face-to-face interactions between the physician and patient and between multidisciplinary teams has challenged patient safety, research investigations, and house staff education. In this study, we discuss how the COVID-19 pandemic has transformed our high-volume pancreatic multidisciplinary clinic, the unique challenges faced, as well as the potential benefits that have arisen out of this situation. We also reflect on its implications for the future during and beyond the pandemic as we anticipate a hybrid model that includes a component of virtual multidisciplinary clinics as a means to provide accessible world-class healthcare for patients who require complex oncologic management.
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Affiliation(s)
- Ammar A Javed
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Joseph R Habib
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benedict Kinny-Köster
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Hodgin
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lindsay Parish
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dea Cunningham
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Hacker-Prietz
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A Burkhart
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William R Burns
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher R Shubert
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John L Cameron
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda C H Chu
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Satomi Kawamoto
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth D Thompson
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eun J Shin
- Department of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol Narang
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lei Zheng
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel A Laheru
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Elliot K Fishman
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kelly Lafaro
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Regasa T, Zemedkun A, Neme D, Aweke Z, Tadese M, Getachew H, Alemu B, Hailu S. The impact of novel coronavirus disease (COVID-19) on emergency and essential surgical care in Gedeo and Sidama zone hospitals: An institutional-based multicenter cross-sectional study. Ann Med Surg (Lond) 2022; 77:103656. [PMID: 35475173 PMCID: PMC9023362 DOI: 10.1016/j.amsu.2022.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background COVID-19 was initially detected in China's Wuhan, the capital of Hubei Province, in December 2019, and has since spread throughout the world, including Ethiopia. Long-term epidemics will overwhelm the capacity of hospitals and the health system as a whole, with dire consequences for the developing world's damaged health systems. Focusing on COVID-19-related activities while continuing to provide essential services such as emergency and essential surgical care is critical not only to maintaining public trust in the health system but also to reducing morbidity and mortality from other illnesses. The goal of this study was to see how COVID-19 affected essential and emergency surgical care in Gedeo and Sidama zone hospitals. Method ology: A cross-sectional study was carried out in ten (10) hospitals in the Gedeo and Sidama zone. The information was gathered with the help of the world health organization (WHO) situational analysis tool for determining emergency and essential surgical care (EESC) capability. Infrastructure, human resources, interventions, and EESC equipment and supplies were used to assess the hospitals' capacity. Result 54.3% of the 35 fundamental therapies indicated in the instrument were available before COVID-19 at all sites, while 25.2 percent were available after the COVID-19 pandemic. During the COVID-19 pandemic, there was a sharing of resources for treatment centers, such as a scarcity of oxygen and anesthesia machines, and emergency surgery was postponed. Before admission, the average distance traveled was 58 km. Conclusion The COVID-19 pandemic, as well as existing disparities in infrastructure, human resources, service provision, and essential equipment and supplies, reveal significant gaps in hospitals' capacity to provide emergency and essential surgical services and effectively address the growing surgical burden of disease and injury in Gedeo and Sidama zone primary, general, and referral hospitals. 54.3% of basic interventions were available before COVID-19 at all facilities reduced to 25.2%. COVID-19 pandemic high effect on emergency and essential surgical cervices. Discrepancies in infrastructure, human resources, and other services also affect EESC.
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Affiliation(s)
- Teshome Regasa
- Anesthesia Department, Dilla University, Dilla, Ethiopia
- Corresponding author.
| | | | - Derartu Neme
- Anesthesia Department, Dilla University, Dilla, Ethiopia
| | - Zemedu Aweke
- Anesthesia Department, Dilla University, Dilla, Ethiopia
| | - Muddin Tadese
- Anesthesia Department, Dilla University, Dilla, Ethiopia
| | | | - Belete Alemu
- Anesthesia Department, Hawassa University, Hawassa, Ethiopia
| | - Seyoum Hailu
- Anesthesia Department, Dilla University, Dilla, Ethiopia
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Eppenberger LS, Golla K, Schmid MK. Emergency Vitrectomies for Retinal Detachment Before and During the Coronavirus Pandemic - A Retrospective Single Centre Analysis. Klin Monbl Augenheilkd 2022; 239:476-483. [PMID: 35472790 PMCID: PMC9042420 DOI: 10.1055/a-1808-6258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background
While the corona pandemic and the resulting containment measures affect the number of elective surgical procedures, the impact on emergency surgical interventions is less
tangible. This analysis quantifies the frequency of emergency vitrectomies for retinal detachment and investigates underlying factors.
Methods
Retrospective identification of patients who underwent primary emergency vitrectomies for retinal detachment at the Cantonal Hospital of Lucerne between
01.01.2018 – 31.12.2020. Parameters were collected, including demographics, date of hospitalisation, reported onset of symptoms, pre-operative best corrected visual acuity (BCVA),
involvement of the macula, and canton of residence.
Results
Overall, a total of 665 patients with 683 eyes underwent emergency surgery for primary retinal detachment in the time span of 01.01.2018 – 31.12.2020. Median monthly number
of surgeries was 20. During the first Swiss national lockdown (16.03.2020 – 19.04.2020), a minimum of 9 vitrectomies was recorded in March 2020. A maximum of 36 vitrectomies was conducted in
August 2020. The mean age of patients was 61.5 years. Of the 665 patients, 133 (20.0%) were residents of the canton of Ticino. Median pre-operative BCVA was 0.25 over all three years, and no
significant reduction in pre-operative BCVA was observed during or after the lockdown. The proportion of eyes with involvement of the macula was 52.2%. In 2018, this proportion (47.6%) was
significantly lower than in 2019 and 2020 (Chi
2
test, p < 0.001). However, cases with macular involvement in post lockdown months were not more frequent. Median time in days
from reported symptom onset to hospitalisation was 5 days. In April 2020, the proportion of patients with > 14 days symptom duration was significantly higher (Chi
2
test,
p < 0.001). During the lockdown, there was a significant reduction in cases from Ticino. Also, patients from Ticino showed proportionally longer symptom duration after the lockdown.
Conclusion
A significant reduction in the number of emergency vitrectomies was observed for the initial period of the coronavirus pandemic. Delayed emergency presentation is not
assumed, since there was no increase in severity (i.e. macular involvement) or prolonged symptoms in the months following the lockdown. More protracted symptoms were only observed in
patients from Ticino. The initial low numbers were generally made good later in the year.
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Affiliation(s)
- Leila Sara Eppenberger
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.,Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Kathrin Golla
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland
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Yiasemidou M. The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future. Indian J Surg 2021; 84:1-8. [PMID: 34149230 DOI: 10.1007/s12262-021-02964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic and infection control measures had an unavoidable impact on surgical services. During the first wave of the pandemic, elective surgery, endoscopy, and 'face-to-face' clinics were discontinued after recommendations from professional bodies. In addition, training courses, examinations, conferences, and training rotations were postponed or cancelled. Inadvertently, infection control and prevention measures, both within and outside hospitals, have caused a significant negative impact on training. At the same time, they have given space to new technologies, like telemedicine and platforms for webinars, to blossom. While the recovery phase is well underway in some parts of the world, most surgical services are not operating at full capacity. Unfortunately, some countries are still battling a second or third wave of the pandemic with severely negative consequences on surgical services. Several studies have looked into the impact of COVID-19 on surgical training. Here, an objective overview of studies from different parts of the world is presented. Also, evidence-based solutions are suggested for future surgical training interventions.
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49
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Yartsev VD, Atkova EL. [The role of local antiseptics in the prevention of coronavirus infection during endonasal interventions on the lacrimal ducts]. Vestn Otorinolaringol 2022; 87:75-80. [PMID: 35274896 DOI: 10.17116/otorino20228701175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In connection with the pandemic of coronavirus infection, it is urgent to develop measures to prevent the intraoperative spread of coronavirus particles and infection of the operating room staff. OBJECTIVE Generalization and analysis of available data concerning local antiseptic therapy for the prevention of coronavirus infection during endonasal interventions on the lacrimal tract. MATERIAL AND METHODS The search for literature sources was carried out using MEDLINE search engines and the Russian Science Citation Index for queries with the keywords "COVID-19", "coronavirus infection", "antiseptics", "protocol for otorhinolaryngological operations", "dacryosurgical operations" and similar in various combinations. RESULTS It has been shown that during endonasal operations on the lacrimal tract, the number of risk factors for infection increases, since these procedures are aerosol-generating, and contact occurs not only with the nasal mucosa, but also with the lacrimal fluid, in which the coronavirus is also replicated. The data on the effectiveness of various antiseptics are summarized, the analysis of the possibility of their use in preoperative preparation for endonasal interventions on the lacrimal tract from the point of view of efficacy and safety is carried out. Information is provided on the proprietary protocol for the use of antiseptics to prevent the spread of coronavirus infection during endonasal dacryocystorhinostomy. It is shown that the preventive use of local disinfectants reduces the number of viral particles on the nasal mucosa, which leads to a decrease in contamination of the surrounding space. Among the available and studied antiseptics, the most suitable is povidone-iodine, which can be used in concentrations up to 1.25% to irrigate the nasal mucosa before surgery with an exposure of 30-60 sec. When performing operations on the lacrimal pathways, it is also advisable to carry out antiseptic treatment of the conjunctival cavity with a 5% solution of povidone-iodine and rinse the lacrimal pathways before the operation with povidone-iodine in a concentration of 0.4%. CONCLUSION To date, information has been obtained that makes it advisable to use antiseptics before performing endonasal aerosol-generating interventions, in particular endonasal dacryocystorhinostomies and recanalization of the tear ducts.
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Affiliation(s)
- V D Yartsev
- Research Institute of Eye Diseases, Moscow, Russia
| | - E L Atkova
- Research Institute of Eye Diseases, Moscow, Russia
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50
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Lisboa LA, Mejia OAV, Arita ET, Guerreiro GP, Silveira LMVD, Brandão CMDA, Dias RR, Dallan LRP, Miana L, Caneo LF, Jatene MB, Dallan LAO, Jatene FB. Impacto da Primeira Onda da Pandemia de COVID-19 na Cirurgia Cardiovascular no Brasil: Análise de um Centro Terciário de Referência. Arq Bras Cardiol 2022; 118:663-666. [PMID: 35319617 PMCID: PMC8959023 DOI: 10.36660/abc.20210235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/08/2021] [Indexed: 01/13/2023] Open
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