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Vissio E, Falco EC, Scozzari G, Scarmozzino A, Trinh DAA, Morino M, Papotti M, Bertero L, Cassoni P. The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis. J Clin Med 2021; 10:jcm10225254. [PMID: 34830534 PMCID: PMC8618829 DOI: 10.3390/jcm10225254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/01/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023] Open
Abstract
The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.
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Affiliation(s)
- Elena Vissio
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Enrico Costantino Falco
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Gitana Scozzari
- Hospital Medical Direction, Molinette Hospital, “Città della Salute e della Scienza di Torino” University Hospital, 10126 Turin, Italy; (G.S.); (A.S.)
| | - Antonio Scarmozzino
- Hospital Medical Direction, Molinette Hospital, “Città della Salute e della Scienza di Torino” University Hospital, 10126 Turin, Italy; (G.S.); (A.S.)
| | - Do An Andrea Trinh
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Mario Morino
- General Surgery 1U, Department of Surgical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy;
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy;
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
- Correspondence: ; Tel.: +39-0116336181
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
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Karlafti E, Benioudakis ES, Paramythiotis D, Sapalidis K, Kaiafa G, Didangelos T, Michalopoulos A, Kesisoglou I, Savopoulos C. Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital. Medicina (Kaunas) 2021; 57:1185. [PMID: 34833403 DOI: 10.3390/medicina57111185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.
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Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. Medicina (Kaunas) 2021; 57:medicina57101127. [PMID: 34684164 PMCID: PMC8538273 DOI: 10.3390/medicina57101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Gloria Burini
- General & Emergency Surgical Clinic, University of Ancona, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-34-6570-0300
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Francesco Barberini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, 20099 Milano, Italy;
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | | | - Gabrio Bassotti
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
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Gallo G, Ortenzi M, Grossi U, Di Tanna GL, Pata F, Guerrieri M, Sammarco G, Di Saverio S. What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review. World J Clin Cases 2021; 9:6759-6767. [PMID: 34447822 PMCID: PMC8362525 DOI: 10.12998/wjcc.v9.i23.6759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/15/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients’ visits have been cancelled or postponed worldwide.
AIM To systematically explore the impact of the pandemic in the management of ACD.
METHODS MEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown).
RESULTS A total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained.
CONCLUSION During the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro 88011, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona 60121, Italy
| | - Ugo Grossi
- 2nd Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Treviso 31100, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney 2050, NSW, Australia
| | - Francesco Pata
- Department of General Surgery, Ospedale Nicola Giannettasio, Corigliano-Rossano 87064, Italy
- La Sapienza University, Roma 00185, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona 60121, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University "Magna Graecia" Medical School, University of Catanzaro, Catanzaro 88100, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, Varese 21100, Italy
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Barabino M, Piccolo G, Trizzino A, Fedele V, Ferrari C, Nicastro V, Pisani Ceretti A, De Nicola E, Mariani NM, Giovenzana M, Scifo G, Mazza M, Vercelli R, Santambrogio R, Luigiano C, Opocher E. COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy. BMC Surg 2021; 21:180. [PMID: 33823831 PMCID: PMC8022294 DOI: 10.1186/s12893-021-01137-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/29/2020] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.
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Affiliation(s)
- Matteo Barabino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Gaetano Piccolo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Arianna Trizzino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Veronica Fedele
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Carlo Ferrari
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy.
| | - Vincenzo Nicastro
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Andrea Pisani Ceretti
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Enrico De Nicola
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Nicolò Maria Mariani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Giovanna Scifo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Massimiliano Mazza
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Ruggero Vercelli
- Department of Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Roberto Santambrogio
- Unit of General Surgery, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
| | - Enrico Opocher
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142, Milan, Italy
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