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Mudarra Vela AM, Rivas Ruiz F, Atienza Carrasco J, Medina Cano FJ. Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area. Rev Gastroenterol Mex (Engl Ed) 2023; 88:354-360. [PMID: 35810102 PMCID: PMC9192794 DOI: 10.1016/j.rgmxen.2022.06.008] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.
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Affiliation(s)
- A M Mudarra Vela
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain.
| | - F Rivas Ruiz
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain; Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - J Atienza Carrasco
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - F J Medina Cano
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain; Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Rodríguez-Fernández L, Sánchez-Santos R, Cano-Valderrama Ó, Fernández-Rodríguez P, Fernández-Veiga MP, Flores-Rodríguez EV, Vigorita V, Paniagua-García-Señoráns M, Moncada-Iribarren E. Evolución de la cirugía urgente en un servicio de cirugía general durante la pandemia de COVID-19 y comparación con una cohorte histórica. CIR CIR 2023; 91:21-27. [PMID: 36787606 DOI: 10.24875/ciru.21000879] [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: 02/16/2023]
Abstract
BACKGROUND Acute care surgery decreased during the first wave of the COVID-19 pandemic. OBJECTIVE To study the evolution of acute care surgery and its relationship with the pandemic severity. METHOD Retrospective cohort study which compared patients who underwent acute care surgery during the pandemic to a control group. RESULTS A total of 660 patients were included (253 in the control group, 67 in the first-wave, 193 in the valley, and 147 in the second wave). The median daily number of acute care surgery procedures was 2 during the control period. This activity decreased during the first wave (1/day), increased during the valley (2/day), and didn't change in the second wave (2/day). Serious complications were more common during the first wave (22.4%). A negative linear correlation was found between the daily number of acute care surgery procedures, number of patients being admitted to the hospital each day and daily number of patients dying because of COVID-19. CONCLUSIONS Acute care surgery was reduced during the first wave of the COVID-19 pandemic, increased during the valley, and returned to the pre-pandemic level during the second wave. Thus, acute care surgery was related to pandemic severity, with fewer surgeries being performed when the pandemic was more severe.
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Affiliation(s)
- Laura Rodríguez-Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Raquel Sánchez-Santos
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Óscar Cano-Valderrama
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Paula Fernández-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - María P Fernández-Veiga
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Erene V Flores-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Vincenzo Vigorita
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Marta Paniagua-García-Señoráns
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
| | - Enrique Moncada-Iribarren
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo.,Instituto de Investigación Sanitaria Galicia Sur. Vigo, España
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Ugarte-Sierra B, Landaluce-Olavarria A, Cabrera-Serna I, Viñas-Trullen X, Brugiotti C, Ramírez-Rodríguez JM, Arroyo A. Enhanced Recovery After Emergency Surgery: Utopia or Reality? Cir Esp 2021; 99:258-66. [PMID: 32532473 DOI: 10.1016/j.ciresp.2020.04.017] [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: 11/03/2019] [Revised: 04/19/2020] [Accepted: 04/26/2020] [Indexed: 11/20/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. The aim of this article is to show ERAS measures currently available according to the existing evidence for emergency surgery.
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Sánchez Acedo P, Eguaras Córdoba I, Zazpe Ripa C, Herrera Cabezón J, Tarifa Castilla A. Prospective Study of Factors Associated With Postoperative Delirium After Urgent Abdominal Surgery. Cir Esp 2020; 98:450-455. [PMID: 32248983 DOI: 10.1016/j.ciresp.2020.01.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Delirium is a frequent complication in elderly patients after urgent abdominal surgery. METHODS Prospective study of consecutive patients aged ≥65years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium. RESULTS The study includes 446 patients with a median age of 78years, 63.6% were ASA ≥III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P<.001; OR: 1,08; 95%CI: 1,038-1,139), ASA (P=.026; OR: 3.15; 95%CI: 1.149-8.668), physiological state (P<.001; OR: 5.8; 95%CI: 2.176-15.457), diagnosis (P=.006) and cognitive impairment (P<.001; OR: 5.8; 95%CI: 2.391-14.069). CONCLUSION The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment.
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Affiliation(s)
| | | | - Cruz Zazpe Ripa
- Cirugía General, Complejo Hospitalario de Navarra, Navarra, España
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España Fuente L, de la Rica Fernández P, González González JL. Use of King Vision ® videolaryngoscope in an unanticipated difficult airway in an adult patient with giant vallecular cyst, a case report. ACTA ACUST UNITED AC 2016; 64:108-111. [PMID: 27692621 DOI: 10.1016/j.redar.2016.08.003] [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: 04/11/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022]
Abstract
Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision® videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital.
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Affiliation(s)
- L España Fuente
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España.
| | - P de la Rica Fernández
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España
| | - J L González González
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España
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Valenzuela Martínez MJ, Martínez Ubieto F, Cruz López AM, Gómez Ara AM. [Reversion of oral anticoagulation in emergency surgery]. Emergencias 2015; 27:316-318. [PMID: 29087057] [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] [Indexed: 06/07/2023]
Abstract
Bleeding is the most serious adverse effect of oral anticoagulants. Emergency surgery requires the rapid reversion of coagulation disorder though the use of such products as prothrombin complex, vitamin K, or activated recombinant factor VII. We analyze the cases of 5 patients on oral anticoagulants (vitamin K antagonists) who required emergency surgery in our hospital in the past year. We describe patient characteristics, laboratory findings before and after correction of anticoagulant effects, preoperative treatment of coagulation disorder, surgical interventions, and outcomes.
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Hidalgo F, Gómez-Luque A, Ferrandis R, Llau JV, de Andrés J, Gomar C, Sierra P, Castillo J, Torres LM. [Perioperative management of direct oral anticoagulant in emergency surgery and bleeding. Haemostasis monitoring and treatment]. ACTA ACUST UNITED AC 2015; 62:450-60. [PMID: 25702199 DOI: 10.1016/j.redar.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/23/2014] [Revised: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect.
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Affiliation(s)
- F Hidalgo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - A Gómez-Luque
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España.
| | - R Ferrandis
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - J V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - J de Andrés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - C Gomar
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - P Sierra
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Fundación Puigvert (IUNA), Barcelona, España
| | - J Castillo
- Servicio de Anestesiología, Hospital del Mar, Barcelona, España
| | - L M Torres
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Puerta del Mar, Cádiz, España
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