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Filip F, Terteliu-Baitan M, Avramia R, Filip R, Cocuz ME. Clinical management and complications of acute appendicitis in 3 children with SARS-CoV-2 infection: Case report. Medicine (Baltimore) 2024; 103:e40105. [PMID: 39470524 DOI: 10.1097/md.0000000000040105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2024] Open
Abstract
RATIONALE Sporadic cases of acute appendicitis (AA) in children with SARS-CoV-2 infection were still recorded at the end of COVID-19 pandemics. We consider that analyses of clinical courses and outcomes is useful to improve the clinical management of such cases in the setting of a general hospital. PATIENT CONCERNS Patient #1 was a 14-year-old girl who presented with nausea, right lower quadrant (RLQ) pain, myalgia, ad low-grade fever for 24 hours. Patient #2 was a 7-year-old boy with a 3-day history of abdominal pain, nausea and vomiting, and fever lasting for 4 days. Patient # 3 was a 16-year-old girl RLQ pain, nausea and vomiting, and fever lasting for 7 days. DIAGNOSES The patients were diagnosed with acute appendicitis (AA) based on the clinical picture, labs and abdominal ultrasound (US) findings. SARS-CoV- 2 infection was diagnosed using rapid antigen test performed at admission. INTERVENTIONS The patients were started on i.v. Ceftriaxone and Metronidazole, antalgics and i.v. fluids at admission. Appendectomy was performed the day after admission in patients # 1 and #2, and after 48 hours in patient #3. OUTCOMES Patient #1 had no complications and was discharged on postoperative day (POD) #5. Patient #2 developed a cecal fistula on POD #4 which was treated conservatively with Ertapenem, i.v. fluids, and local placement of colostomy bag. The fistula closed spontaneously on POD #12. He was discharged on POD #17. Patient #3 developed a postoperative abscess on POD # 6 and required laparoscopic surgical drainage of the abscess. She was discharged after another 6 days (POD #12). No patient required ICU admission, steroids, or supplemental O2 use during their hospitalization. There were no late complications or readmissions in these patients. LESSONS We consider that AA in these SARS-CoV-2 positive children had a similar course with SARS-CoV-2 negative cases. Compliance to previously established COVID-19 protocols was useful to improve the outcome. The parents should bring the sick child early to the hospital in order to avoid complications related to delayed presentation and not to SARS-CoV-2 infection itself.
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Affiliation(s)
- Florin Filip
- College of Medicine and Biological Sciences, Stefan Cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | - Monica Terteliu-Baitan
- College of Medicine and Biological Sciences, Stefan Cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | - Ramona Avramia
- College of Medicine and Biological Sciences, Stefan Cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | - Roxana Filip
- College of Medicine and Biological Sciences, Stefan Cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | - Maria Elena Cocuz
- Fundamental Prophylactic and Clinical Disciplines Department, Faculty of Medicine, Transilvania University of Brasov, Brașov, Romania
- Clinical Infectious Diseases Hospital of Brasov, Brasov, Romania
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Lin F, Vaserman G, Spencer E, Choudhury M, Phillips J. Rise of long-distance urology transfer during the COVID-19 pandemic: Identifying factors to enhance transfers of care efficiency and clinical outcomes. Int J Urol 2024. [PMID: 39258710 DOI: 10.1111/iju.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE The objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic. METHODS After IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 ("pre-COVID") and from 01/02/2020 to 12/31/2022 ("COVID"). We identified demographics, origin hospitals, ICD-10 pre- and post-transfer diagnoses, distance of transfer, and post-transfer CPT codes. RESULTS During the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the "pre-COVID" cohort and 111/160 (70%) made up the "COVID" cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre-COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre-COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 - 2.58, p < 0.01). Different diagnosis upon re-evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09-0.97, p = 0.05). CONCLUSIONS Long-distance transfer, even >100 miles (which we termed "mega-transfers"), was a new pandemic-related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter-institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.
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Affiliation(s)
- Fangyi Lin
- New York Medical College, Valhalla, New York, USA
| | - Grigori Vaserman
- New York Medical College, Valhalla, New York, USA
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - Evan Spencer
- New York Medical College, Valhalla, New York, USA
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - Muhammad Choudhury
- New York Medical College, Valhalla, New York, USA
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - John Phillips
- New York Medical College, Valhalla, New York, USA
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
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Wang J, Wu Z, Shi S, Ren J, Ren X. Nurse-led care versus neurologist-led care for long-term outcomes of patients who underwent craniotomy in traumatic brain injuries: an efficacy analysis. Front Neurol 2024; 15:1382696. [PMID: 39131050 PMCID: PMC11309991 DOI: 10.3389/fneur.2024.1382696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/08/2024] [Indexed: 08/13/2024] Open
Abstract
Background After craniotomy, patients require rehabilitation efforts for the recovery process, and neurologists are mostly engaged for that (in the management of post-craniotomy complications). However, neurologists are not always available for care after neurosurgery during follow-up (situation of our institute). The objectives of the study were to compare the effects of two different types of care (nurse-led and neurologist-led) on various long-term outcomes in patients who have undergone craniotomy due to traumatic brain injuries. Methods Electronic medical records of patients (aged ≥18 years) who underwent craniotomy for traumatic brain injuries and their caregivers were extracted and retrospectively reviewed. Patients received nurse-led care (NL cohort, n = 109) or neurologist-led care (GL cohort, n = 121) for 6 months after craniotomy. Results Before the nurse-or neurologist-led care (BC), all patients had activities of daily living (ADL) ≤ 11, ≤ 50 quality of life (QoL), and 69% of patients had definitive anxiety, 87% of patients had definitive depression, and all caregivers had Zarit Burden interview scores ≥50. Nurse-led post-surgical care was associated with improved ADL and QoL, relieved anxiety and depression of patients, relieved the burden on caregivers, and the higher overall satisfaction of patients and their caregivers after 6-months of care (AC) as compared to their BC condition (p < 0.05) and also compared to those of patients in the GL cohort under AC condition (p < 0.01). Patients in the GL cohort reported pressure sores (p = 0.0211) and dizziness [15 (12%) vs. 5 (5%)] after craniotomy during follow-up than those in the NL cohort. Conclusion ADL, QoL, and psychological conditions of patients who undergo craniotomy for traumatic brain injuries must be improved and the burdens of their caregivers must be relived. Not only is the care provided by nursing staff equivalent to that offered by neurologists, but in some aspects, it is superior for patients who have undergone craniotomy for traumatic brain injuries and their caregivers during follow-up.
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Affiliation(s)
- Jingjing Wang
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Zhiping Wu
- Teaching and Clinical Skills, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Shufang Shi
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Jiangyan Ren
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Xiaojia Ren
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
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Li L, Zhang H, Dai T, Liu D, Xiao S, Xiao Y, Huang L. Development of a Preoperative Screening Tool to Reduce Morbidity and Mortality of COVID-19-positive Hepatobiliary Patients. J Perianesth Nurs 2024:S1089-9472(24)00121-7. [PMID: 39001741 DOI: 10.1016/j.jopan.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/17/2024] [Accepted: 03/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This study aimed to create a preoperative risk assessment form for COVID-19-positive hepatobiliary patients to guide further prevention of complications after surgery and reduce morbidity and mortality. DESIGN Based on the literature, focus groups, and case studies, a multidisciplinary panel of 15 experts conducted three rounds of a Delphi study that resulted in the development of a preoperative risk assessment form to be used by healthcare professionals in the treatment of COVID-19-positive hepatobiliary patients. METHODS A preoperative risk assessment form for health professionals to use among COVID-19-positive hepatobiliary patients was developed based on literature, focus groups, and case studies. A 3-round Delphi study was conducted to validate and revise the risk assessment form using a multidisciplinary panel of 15 experts involved in hepatobiliary surgery. FINDINGS The experts demonstrated high cooperation and familiarity with the research topic, with positive coefficients ranging from 93.33% to 100% and authority coefficients ranging from 0.83 to 0.86. The coordination coefficients were 0.33, 0.26, and 0.22, respectively, indicating good coordination among expert opinions. The final risk assessment form included 9 primary (first-level) indicators, 38 secondary (second-level) indicators, and 122 tertiary (third-level) indicators. CONCLUSIONS The preoperative risk assessment form for hepatobiliary surgery patients infected with COVID-19 is scientifically rigorous, reliable, and valid. This screening tool may be used by health providers to identify high-risk patients, prevent postoperative complications, and reduce morbidity and mortality.
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Affiliation(s)
- Lihui Li
- Hunan Provincial People's Hospital (The First Hospital Affiliated to Hunan Normal University), Changsha, Hunan, China
| | - Honghui Zhang
- Hunan Provincial People's Hospital (The First Hospital Affiliated to Hunan Normal University), Changsha, Hunan, China.
| | - Ting Dai
- Hunan Provincial People's Hospital (The First Hospital Affiliated to Hunan Normal University), Changsha, Hunan, China
| | - Dan Liu
- Hunan Provincial People's Hospital (The First Hospital Affiliated to Hunan Normal University), Changsha, Hunan, China
| | - Shan Xiao
- Hunan Provincial People's Hospital (The First Hospital Affiliated to Hunan Normal University), Changsha, Hunan, China
| | - Yuting Xiao
- Hunan Provincial People's Hospital (The First Hospital Affiliated to Hunan Normal University), Changsha, Hunan, China
| | - Ling Huang
- Tibet Autonomous Region Blood Center, Lhasa, Tibet Autonomous Region, China
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Gozalichvili D, Fournel I, Sow AK, Guiraud A, Moreno-Lopez N, Orry D, Facy O, Ortega-Deballon P. Management of patients with high C-reactive protein levels after elective colorectal surgery: Pilot study on a proactive diagnostic and therapeutic approach (GESPACE). J Visc Surg 2024:S1878-7886(24)00084-5. [PMID: 38908988 DOI: 10.1016/j.jviscsurg.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
STUDY OBJECTIVE To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery. PATIENTS AND METHODS Prospective study including patients with CRP>125mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15d. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit. RESULTS One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay<15d. Major deviations from the management algorithm occurred in 38% of cases. No patients had an early endoscopy. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed. CONCLUSION It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management.
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Affiliation(s)
| | - Isabelle Fournel
- Clinical Investigation Centre, Dijon University Hospital, Dijon, France; INSERM, CIC 1432, Clinical Epidemiology Module, Dijon, France
| | - Amadou Khalilou Sow
- Clinical Investigation Centre, Dijon University Hospital, Dijon, France; INSERM, CIC 1432, Clinical Epidemiology Module, Dijon, France
| | - Adeline Guiraud
- Digestive Surgery Department, Dijon University Hospital, Dijon, France
| | | | - David Orry
- Cancer Surgery Department, Georges-François Leclerc Cancer Centre, Dijon, France
| | - Olivier Facy
- Digestive Surgery Department, Dijon University Hospital, Dijon, France; INSERM UMR 1231, University of Burgundy, Dijon, France
| | - Pablo Ortega-Deballon
- Digestive Surgery Department, Dijon University Hospital, Dijon, France; Clinical Investigation Centre, Dijon University Hospital, Dijon, France; INSERM, CIC 1432, Clinical Epidemiology Module, Dijon, France; INSERM UMR 1231, University of Burgundy, Dijon, France.
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Zmora O, Fleshner P, Barie PS, Segev L, Viola GM, Senagore AJ, Spinelli A, Belotserkovsky O, Sharoni S, Emanuel N. Effect of local prolonged-release incisional doxycycline on surgical site infection prophylaxis in abdominal colorectal surgery: The SHIELD 1 randomized clinical trial. Int J Surg 2024; 110:01279778-990000000-01655. [PMID: 38869970 PMCID: PMC11486998 DOI: 10.1097/js9.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Despite advanced infection control practices including preoperative antibiotic prophylaxis, surgical site infection (SSI) remains a challenge. This study aimed to test whether local administration of a novel prolonged-release Doxycycline-Polymer-Lipid Encapsulation matriX (D-PLEX) before wound closure, concomitantly with standard of care (SOC), reduces the incidence of incisional SSI after elective abdominal colorectal surgery. MATERIALS AND METHODS This was a phase 3 randomized, controlled, double-blind, multinational study (SHIELD 1) between June 2020 to June 2022. Patients with at least one abdominal incision length >10 cm were randomized 1:1 to the investigational arm (D-PLEX+SOC) or control (SOC) arm . The primary outcome was a composite of incisional SSI, incisional reintervention, and all-cause mortality. RESULTS A total of 974 patients were analyzed, of whom 579 (59.4%) were male. The mean age (±SD) was 64.2±13.0 years. The primary outcome occurred in 9.3% of D-PLEX patients versus 12.1% (SOC) (risk difference estimate [RDE], -2.8%; 95% CI [-6.7%, 1.0%], P=0.1520). In a pre-specified analysis by incision length, a reduction in the primary outcome was observed in the >20 cm subpopulation: 8% (D-PLEX) versus 17.5% (SOC) (RDE, -9.4%; 95% CI [-15.5%, -3.2%], P=0.0032). In the >10 to ≤20 cm subgroup, no reduction was observed: 9.9% versus 7.9% (RDE, 2.0%; 95% CI [-2.8%, 6.7%], P=0.4133). Exploratory post-hoc analyses of patients with increased SSI risk (≥1 patient-specific comorbidity) indicated a reduction in the incidence of the primary outcome: 9.0% (D-PLEX) versus 13.7% (SOC) (RDE, -4.8%; 95% CI [-9.5%, -0.1%], P=0.0472). The D-PLEX safety profile was good (no difference in treatment-emergent adverse events between the groups). CONCLUSIONS The SHIELD-1 study did not meet its primary outcome of reduced incisional SSI, incisional reinterventions, or all-cause mortality. Pre-specified and post-hoc analyses suggested that D-PLEX may reduce the incidence of the primary outcome event in patients with increased SSI risk, including lengthy incisions.
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Affiliation(s)
- Oded Zmora
- Department of Surgery, Shamir Medical Center, Be’er Ya’akov
| | - Phillip Fleshner
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Lior Segev
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - George M. Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Ielmini M, Casarin J, Callegari C, Bellini A, Favata MG, Giudici A, Ghezzi F, Cromi A, Caselli I. Pre-Pandemic Predictivity of Anxious-Depressive Symptoms in Post-Surgical Traumatic Distress in Hysterectomy for Benign Disease and COVID-19 Outbreak: A Case-Control Study. J Clin Med 2024; 13:3148. [PMID: 38892859 PMCID: PMC11172625 DOI: 10.3390/jcm13113148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic led to several needed containment measures that conditioned the onset of depressive, anxiety, and post-traumatic stress symptoms in the population. These symptoms, especially if not diagnosed and treated, can also occur in patients undergoing medical care or surgery, with a high impact on people's lives and causing low adherence to treatment. The study evaluates whether the spread of the coronavirus disease 2019 (COVID-19) worsened the onset of post-surgical distress and symptoms of anxiety and depression in a population undergoing hysterectomy for benign disease during the pandemic era, comparing it with a population with the same characteristics but recruited before COVID-19. Methods: The sample was evaluated before surgery (T1), post-operatively (T2), and 3 months after surgery (T3) through a sociodemographic questionnaire and through the HADS (Hospital Anxiety and Depression Scale) to evaluate anxious-depressive symptoms and the PCL-5 (Post-traumatic Stress Disorder Checklist for DSM-5) to assess the onset of post-surgical distress. Results: Patients treated after the COVID-19 pandemic showed a higher depressive symptoms rate compared with those treated before (p-value = 0.02); conversely, pre-COVID-19 patients were more prone to develop post-traumatic stress disorder (PTSD) (p-value = 0.04). A significant association between the occurrence of PTSD and anxiety-depressive symptoms registered at T2 (p-value = 0.007) and T3 (p-value < 0.0001) emerged. In the end, the COVID-19 pandemic has exerted a detrimental influence on the mental well-being of the patients under investigation, with a notable exacerbation of their mood disturbances. Conclusions: The findings advocate for the implementation of psychometric and psychodiagnostic assessments to promptly detect high-risk scenarios that could lead to PTSD, compromising treatment compliance and exacerbating the overall outcome, resulting in substantial direct and indirect burdens.
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Affiliation(s)
- Marta Ielmini
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy; (M.I.); (C.C.); (M.G.F.)
| | - Jvan Casarin
- Obstetrics and Gynecology Department, University of Insubria, 21100 Varese, Italy; (J.C.); (A.G.); (F.G.); (A.C.)
| | - Camilla Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy; (M.I.); (C.C.); (M.G.F.)
| | - Alessandro Bellini
- Department of Applied and Psychobehavioral Sciences, Division of Psychiatry, University of Pavia, 27100 Pavia, Italy;
| | - Manuela Giada Favata
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy; (M.I.); (C.C.); (M.G.F.)
| | - Anna Giudici
- Obstetrics and Gynecology Department, University of Insubria, 21100 Varese, Italy; (J.C.); (A.G.); (F.G.); (A.C.)
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department, University of Insubria, 21100 Varese, Italy; (J.C.); (A.G.); (F.G.); (A.C.)
| | - Antonella Cromi
- Obstetrics and Gynecology Department, University of Insubria, 21100 Varese, Italy; (J.C.); (A.G.); (F.G.); (A.C.)
| | - Ivano Caselli
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy; (M.I.); (C.C.); (M.G.F.)
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Rasic G, Collado L, Kobzeva-Herzog A, Dechert T. Standing in Unity Amidst Change: A Group Mentorship Model that Addresses the Logistical and Emotional Needs of Applicants for Surgical Residency. JOURNAL OF SURGICAL EDUCATION 2024; 81:161-166. [PMID: 38160112 DOI: 10.1016/j.jsurg.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/14/2023] [Accepted: 11/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE For medical students, applying to general surgery residency is a complex and multifactorial process that can be fraught with significant challenges. The COVID-19 pandemic generated additional uncertainty and distress for applicants given the temporary suspension of in-person clinical rotations and transition to virtual residency interviews. However, despite the significant changes introduced by the COVID-19 pandemic, our group mentorship model - originally developed to address the emotional and logistical needs of applicants - withstood national shifts in medical education. In this manuscript, we detail the rationale and design of our group mentorship model for fourth-year medical students with the hopes that other programs may implement our current resources and acquire insight from the lessons we learned amidst responding to the changing climate in surgical education. DESIGN Implementation of a longitudinal program utilizing a group mentorship model to provide students with emotional and logistical support during the residency application process. SETTING This program was implemented at the Boston University Chobanian & Avedisian School of Medicine. PARTICIPANTS Fourth-year medical students that are applying to general surgery residency. RESULTS The program consisted of 11 sessions, ranging from 1-2 hours in duration, and approximately 14-17 students participated in the program per year. The program was led by a mentor panel that consisted of a faculty advisor, resident physicians, and appointed student liaisons. CONCLUSIONS Group mentorship is a unique model that allows for multidirectional dissemination of advice and experiences amidst student participants and mentors. In times of shifts in medical education, the diverse mentor panel allows for the development of strategies to address unanticipated challenges encountered during the application process.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Loreski Collado
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Anna Kobzeva-Herzog
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Tracey Dechert
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Badrudin D, Lesurtel M, Shrikhande S, Gallagher T, Heinrich S, Warner S, Chaudhari V, Koo D, Anantha S, Molina V, Calvo MP, Allard MA, Doussot A, Kourdouli A, Efanov M, Oddi R, Barros-Schelotto P, Erkan M, Lidsky M, Garcia F, Gelli M, Kaldarov A, Granero P, Meurisse N, Adam R. International Hepato-Pancreato-Billiary Association (IHPBA) registry study on COVID-19 infections in HPB surgery patients. HPB (Oxford) 2024; 26:102-108. [PMID: 38038484 DOI: 10.1016/j.hpb.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND In response to the pandemic, the International Hepato-Pancreato-Biliary Association (IHPBA) developed the IHPBA-COVID Registry to capture data on HPB surgery outcomes in COVID-positive patients prior to mass vaccination programs. The aim was to provide a tool to help members gain a better understanding of the impact of COVID-19 on patient outcomes following HPB surgery worldwide. METHODS An online registry updated in real time was disseminated to all IHPBA, E-AHPBA, A-HPBA and A-PHPBA members to assess the effects of the pandemic on the outcomes of HPB procedures, perioperative COVID-19 management and other aspects of surgical care. RESULTS One hundred twenty-five patients from 35 centres in 18 countries were included. Seventy-three (58%) patients were diagnosed with COVID-19 preoperatively. Operative mortality after pancreaticoduodenectomy and major hepatectomy was 28% and 15%, respectively, and 2.5% after cholecystectomy. Postoperative complication rates of pancreatic procedures, hepatic interventions and biliary interventions were respectively 80%, 50% and 37%. Respiratory complication rates were 37%, 31% and 10%, respectively. CONCLUSION This study reveals a high risk of mortality and complication after HPB surgeries in patient infected with COVID-19. The more extensive the procedure, the higher the risk. Nonetheless, an increased risk was observed across all types of interventions, suggesting that elective HPB surgery should be avoided in COVID positive patients, delaying it at distance from the viral infection.
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Affiliation(s)
- David Badrudin
- HPB & Transplant Surgery, Assistant Professor of Surgery, Department of Surgery, Université de Montréal, Montreal, Canada
| | - Mickaël Lesurtel
- Head of HPB Surgery & Liver Transplantation, Beaujon Hospital - University of Paris Cité, Paris, France
| | - Shailesh Shrikhande
- Deputy Director and Head of Cancer Surgery, Tata Memorial Hospital, Mumbai, India
| | | | | | | | - Vikram Chaudhari
- Gastrointestinal and HPB Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Donna Koo
- Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Sandeep Anantha
- Director of Surgical Oncology- LIJ Forest Hills Hospital, New York, USA
| | - Víctor Molina
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Marc-Antoine Allard
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, AP-HP, Villejuif, France
| | | | | | | | - Ricardo Oddi
- Center for Clinical Medical Education and Research (CEMIC), Buenos Aires, Argentina
| | | | - Mert Erkan
- Koç University School of Medicine, Istanbul, Turkey
| | | | | | | | | | - Pablo Granero
- Central University Hospital of Asturias, Oviedo, Spain
| | | | - René Adam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, AP-HP, Villejuif, France.
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Chan JP, Hoang H, Hashmi SZ, Lee YP, Bhatia NN. A temporal analysis of perioperative complications following COVID-19 infection in patients undergoing lumbar spinal fusion: When is it safe to proceed? NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100262. [PMID: 37720242 PMCID: PMC10504527 DOI: 10.1016/j.xnsj.2023.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023]
Abstract
Background Context COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection. Methods We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery. Results A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58-3.32), sepsis (OR 1.56, 95% CI 1.03-2.36), 30-day mortality (OR 5.55, 95% CI 3.53-8.71), and 1-year mortality (OR 2.70, 95% CI 1.91-3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed. Conclusions Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.
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Affiliation(s)
- Justin P. Chan
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Henry Hoang
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Sohaib Z. Hashmi
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
| | - Nitin N. Bhatia
- Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States
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11
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Kudsi OY, Kaoukabani G, Friedman A, Bou-Ayash N, Bahadir J, Gokcal F. Impact of Coronavirus Disease 2019 on Clinical Outcomes of Robotic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2023; 33:592-595. [PMID: 37725816 DOI: 10.1097/sle.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic strained the health care sector, putting severe constraints on surgical departments. In this study, we evaluate the impact of the pandemic on the outcomes of patients undergoing robotic cholecystectomy (RC). PATIENTS AND METHODS Patients who underwent RC 1 year before and after March 2020 were included in this retrospective study and assigned accordingly to the pre or post-COVID group. Pre, intra, and postoperative variables were compared between groups. RESULTS In total, 110 patients were assigned to the pre-COVID group versus 80 in the post-COVID group. There were no differences in the demographics, except for a higher rate of previous gallbladder disease in the pre-COVID group (35.5% vs 13.8,% P < 0.001). The post-COVID group had a higher rate of emergent RCs (62.5% vs 39.1%, P = 0.002). Operative times were greater in the post-COVID group due to the more frequent participation of clinical fellows in the cases. The median hospital length of stay for both groups was 1 day, with higher rates of same-day discharge (pre-COVID 40.9% vs post-COVID 57.5%, P = 0.028). Complications were comparable between both groups, with no recorded cases of COVID-19 contraction within the virus incubation period. The median follow-up was 10 months for the entire cohort. CONCLUSION During the COVID-19 pandemic, an increase in emergent cases, as well as higher rates of same-day discharge, were recorded, with no impact on postoperative outcomes in patients undergoing RC.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Brockton
- Department of Surgery, Tufts University School of Medicine
| | | | | | | | - Jenna Bahadir
- Department of Surgery, Good Samaritan Medical Center, Brockton
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, Brockton
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12
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He LD, Duggan JL, Lans J, Harper CM, Rozental TD. Trends in Orthopedic Management of Distal Radius Fractures Among Medicare Beneficiaries From 2019 to 2020: A Claims Analysis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:717-721. [PMID: 38106940 PMCID: PMC10721538 DOI: 10.1016/j.jhsg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Radius and ulna fractures are among the most common fractures. These fractures are managed through operative or nonsurgical treatment, with varying implications in terms of cost and functional outcome. There are few studies that robustly characterize the management of distal radius fractures (DRFs) in the United States during the COVID-19 pandemic. Furthermore, this has not been studied among the Medicare patient population, who are particularly vulnerable to fragility fractures and COVID-19. The purpose of this study is to analyze the services provided to Medicare beneficiaries both before and during the COVID-19 pandemic to determine how procedure volume was affected in this patient population. Methods We retrospectively analyzed services using the physician or supplier procedure summary data from the Centers for Medicare and Medicaid Services. All services provided by physicians between January 1, 2019, and December 31, 2020, were included. The data were stratified by US census region using insurance carrier number and pricing locality codes. We also compared data between states that maintained governors affiliated with the Democratic or Republican parties for the duration of the study. Results There was an overall decrease in claims regarding DRFs management from 2019 to 2020. There was a dramatic decline in procedure volume (-6.3% vs -12.9%). Of all distal radius related claims there was a relative increase in the proportion of operatively managed DRFs in 2020, from 50.2% to 52.0%. The Midwest saw the greatest decline in operatively managed DRFs, whereas the West experienced the smallest per-capita decline across all procedures. After separating the data by party affiliation, it was also found that operative and nonsurgical procedure volumes fell more sharply in states with Democratic governors. Conclusions This study shows a decrease in DRF procedural volume among Medicare beneficiaries. This data suggests that the operative and nonsurgical management of DRFs may have been affected by pandemic factors such as quarantine guidelines and supply chain or resource limitations. This may assist surgeons and health care systems in predicting how similar crises may affect operative volume. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | | | - Jonathan Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Carl M. Harper
- Division of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara D. Rozental
- Division of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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13
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Alolayan H, Aljohani M, Alfehaid M, AlMatroudi G, AlDhowyan N, AlQathlan J, AlSuhaibani S, AlShamikh T, AlJohani G, AlSalamah A, AlRashidi H. Impact of COVID-19 Vaccination on General Surgical Emergencies in Al-Qassim Region, Saudi Arabia: A Single-Center Retrospective Chart Review. Cureus 2023; 15:e43630. [PMID: 37719613 PMCID: PMC10504863 DOI: 10.7759/cureus.43630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Background This study sought to determine the COVID-19 pandemic and vaccination's effects on the number of patients presenting with emergent surgical illnesses or requiring emergency general surgical procedures. We compared the number of presenting cases and surgical emergencies before the pandemic, in 2019, and during the pandemic, before and after the COVID-19 vaccination's introduction. Method This observational retrospective chart review was conducted at a tertiary hospital in Al-Qassim, Saudi Arabia. The data were retrospectively collected for three periods (July 1 to September 30) in 2019, 2020, and 2021 using a data collection sheet for demographic data, visit date, comorbidities, emergency procedure type, COVID-19 test result, length of hospitalization, ICU admission status, and surgical case mortality. Results The study included 152 participants with a mean age of 36.1 (SD: 16) years, and 69.7% of them were male. Common surgical conditions were identified as acute appendicitis (49.3%), skin abscesses and pilonidal sinus (21.7%), and diabetic foot (9.2%) across all three years. The most frequent (48.7%) surgical procedure was appendectomy. A decrease in surgical emergencies rate was observed during the year 2020, as compared to 2019 and 2021. The general surgery emergency rate was highest in 2021 among patients admitted for procedures post-vaccination (38.8%). Conclusion Common surgical emergencies were most frequent in 2021, after the COVID-19 vaccine's introduction. Future research areas include the impact of the pandemic on delays or the severity and complication of surgical or medical cases.
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Affiliation(s)
- Hayfa Alolayan
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Moath Aljohani
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Mohammed Alfehaid
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Ghadi AlMatroudi
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Noura AlDhowyan
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Joud AlQathlan
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Shoug AlSuhaibani
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Tahani AlShamikh
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Ghadeer AlJohani
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Anwaar AlSalamah
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Hanadi AlRashidi
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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14
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Böckelmann I, Meyer F, Thielmann B. [COVID-19 as an insurance case of the statutory accident insurance: occupational disease or occupational accident : Relevant knowledge for the (general and abdominal) surgeon]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01892-z. [PMID: 37266705 PMCID: PMC10237056 DOI: 10.1007/s00104-023-01892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/03/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was a dramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No. 3101 and the AU are presented.Results (key points)- According to § 7 SGB VII, AU and BK are insured events of the statutory accident insurance.- In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV‑2 infection with post-COVID in personnel for occupational medical prevention and as a case to be recognized by the statutory accident insurance (BK or AU) becomes clear.- Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV‑2 occupational health and safety rule of 20 August 2020 essentially recognizes a contact duration of at least 15 min at a spatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).- No case numbers can be elicited for the detailed presentation of the surgery setting.- There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV‑2 pandemic is a special challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.
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Affiliation(s)
- Irina Böckelmann
- Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Frank Meyer
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg mit Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland.
| | - Beatrice Thielmann
- Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
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15
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Romero-Velez G, Ponce de Leon-Ballesteros G, Al Zubaidi M, Barajas-Gamboa JS, Dang J, Corcelles R, Strong AT, Navarrete S, Kroh M. Presence of SARS-CoV-2 in abdominal tissues and biologic fluids during abdominal surgery: a systematic review. Surg Endosc 2023:10.1007/s00464-023-10130-w. [PMID: 37219799 DOI: 10.1007/s00464-023-10130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Viral transmission to healthcare providers during surgical procedures was a major concern at the outset of the COVID-19 pandemic. The presence of the severe acute respiratory disease syndrome coronavirus (SARS-CoV-2), the virus responsible for COVID-19, in the abdominal cavity as well as in other abdominal tissues which surgeons are exposed has been investigated in several studies. The aim of the present systematic review was to analyze if the virus can be identify in the abdominal cavity. METHODS We performed a systematic review to identify relevant studies regarding the presence of SARS-CoV-2 in abdominal tissues or fluids. Number of patients included as well as patient's characteristics, type of procedures, samples and number of positive samples were analyzed. RESULTS A total of 36 studies were included (18 case series and 18 case reports). There were 357 samples for detection of SARS-CoV-2, obtained from 295 individuals. A total of 21 samples tested positive for SARS-CoV-2 (5.9%). Positive samples were more frequently encountered in patients with severe COVID-19 (37.5% vs 3.8%, p < 0.001). No health-care provider related infections were reported. CONCLUSION Although a rare occurrence, SARS-CoV-2 can be found in the abdominal tissues and fluids. It seems that the presence of the virus in the abdominal tissues or fluids is more likely in patients with severe disease. Protective measures should be employed in the operating room to protect the staff when operating patients with COVID-19.
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Affiliation(s)
- Gustavo Romero-Velez
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Avenue, Mail Code F20, Cleveland, OH, 44195, USA.
| | | | - Maryam Al Zubaidi
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan S Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jerry Dang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ricard Corcelles
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew T Strong
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Salvador Navarrete
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mathew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Argandykov D, Dorken-Gallastegi A, El Moheb M, Gebran A, Proaño-Zamudio JA, Bokenkamp M, Renne AM, Nepogodiev D, Bhangu A, Kaafarani HM. Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis. J Trauma Acute Care Surg 2023; 94:513-524. [PMID: 36949053 PMCID: PMC10044588 DOI: 10.1097/ta.0000000000003859] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients undergoing surgery with perioperative COVID-19 are suggested to have worse outcomes, but whether this is COVID-related or due to selection bias remains unclear. We aimed to compare the postoperative outcomes of patients with and without perioperative COVID-19. METHODS Patients with perioperative COVID-19 diagnosed within 7 days before or 30 days after surgery between February and July 2020 from 68 US hospitals in COVIDSurg, an international multicenter database, were 1:1 propensity score matched to patients without COVID-19 undergoing similar procedures in the 2012 American College of Surgeons National Surgical Quality Improvement Program database. The matching criteria included demographics (e.g., age, sex), comorbidities (e.g., diabetes, chronic obstructive pulmonary disease, chronic kidney disease), and operation characteristics (e.g., type, urgency, complexity). The primary outcome was 30-day hospital mortality. Secondary outcomes included hospital length of stay and 13 postoperative complications (e.g., pneumonia, renal failure, surgical site infection). RESULTS A total of 97,936 patients were included, 1,054 with and 96,882 without COVID-19. Prematching, COVID-19 patients more often underwent emergency surgery (76.1% vs. 10.3%, p < 0.001). A total of 843 COVID-19 and 843 non-COVID-19 patients were successfully matched based on demographics, comorbidities, and operative characteristics. Postmatching, COVID-19 patients had a higher mortality (12.0% vs. 8.1%, p = 0.007), longer length of stay (6 [2-15] vs. 5 [1-12] days), and higher rates of acute renal failure (19.3% vs. 3.0%, p < 0.001), sepsis (13.5% vs. 9.0%, p = 0.003), and septic shock (11.8% vs. 6.0%, p < 0.001). They also had higher rates of thromboembolic complications such as deep vein thrombosis (4.4% vs. 1.5%, p < 0.001) and pulmonary embolism (2.5% vs. 0.4%, p < 0.001) but lower rates of bleeding (11.6% vs. 26.1%, p < 0.001). CONCLUSION Patients undergoing surgery with perioperative COVID-19 have higher rates of 30-day mortality and postoperative complications, especially thromboembolic, compared with similar patients without COVID-19 undergoing similar surgeries. Such information is crucial for the complex surgical decision making and counseling of these patients. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
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17
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Lizambri D, Giacalone A, Shah PA, Tovani-Palone MR. Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic: Current practice and lessons for the future. World J Clin Cases 2023; 11:1434-1441. [PMID: 36926409 PMCID: PMC10011991 DOI: 10.12998/wjcc.v11.i7.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has imposed a radical change in daily life and work routine. In this context, health systems have suffered important and serious repercussions in all fields. Among the changes brought about by the state of global health emergency, adjustments to guidelines, priorities, structures, professional teams, and epidemiological data stand out. In light of this, the oncological field has witnessed several changes in the approach to cancer, whether due to delay in diagnosis, screening deficit, personnel shortage or the psychological impact that the pandemic has had on cancer patients. This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency. In this period, the oral and maxillofacial surgeons have faced many obstacles. The proximity of maxillofacial structures to the airways, the need of elective and punctual procedures in cancerous lesions, the aggressiveness of head and neck tumors, and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field. One of the possible surgical 'solutions' to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps, which in the pre-COVID-19 era were less used than free flaps. However, during the health emergency, its use has been widely reassessed. This setback may represent a precedent for opening up new reflections. In the course of a long-term pandemic, a reassessment of the validity of different medical and surgical therapeutic approaches should be considered. Finally, given that the pandemic has high-lighted vulnerabilities and shortcomings in a number of ways, including the issues of essential resource shortages, underinvestment in public health services, lack of coordination and versatility among politicians, policymakers and health leaders, resulting in overloaded health systems, rapid case development, and high mortality, a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out. This should be directed especially towards improving the management of health systems, their coordination as well as reviewing related practices, even in the surgical field.
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Affiliation(s)
- Daniele Lizambri
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Caserta 81100, Italy
| | - Andrea Giacalone
- Department of Industrial Engineering, Technologies for Sports Medicine and Rehabilitation, University of Rome Tor Vergata, Rome 00133, Italy
| | - Pritik A Shah
- Bangalore Medical College and Research Institute, Karnataka 560002, India
| | - Marcos Roberto Tovani-Palone
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, India
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Excess mortality among non-COVID-19 surgical patients attributable to the exposure of French intensive and intermediate care units to the pandemic. Intensive Care Med 2023; 49:313-323. [PMID: 36840798 PMCID: PMC9959950 DOI: 10.1007/s00134-023-07000-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/03/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The mobilization of most available hospital resources to manage coronavirus disease 2019 (COVID-19) may have affected the safety of care for non-COVID-19 surgical patients due to restricted access to intensive or intermediate care units (ICU/IMCUs). We estimated excess surgical mortality potentially attributable to ICU/IMCUs overwhelmed by COVID-19, and any hospital learning effects between two successive pandemic waves. METHODS This nationwide observational study included all patients without COVID-19 who underwent surgery in France from 01/01/2019 to 31/12/2020. We determined pandemic exposure of each operated patient based on the daily proportion of COVID-19 patients among all patients treated within the ICU/IMCU beds of the same hospital during his/her stay. Multilevel models, with an embedded triple-difference analysis, estimated standardized in-hospital mortality and compared mortality between years, pandemic exposure groups, and semesters, distinguishing deaths inside or outside the ICU/IMCUs. RESULTS Of 1,870,515 non-COVID-19 patients admitted for surgery in 655 hospitals, 2% died. Compared to 2019, standardized mortality increased by 1% (95% CI 0.6-1.4%) and 0.4% (0-1%) during the first and second semesters of 2020, among patients operated in hospitals highly exposed to pandemic. Compared to the low-or-no exposure group, this corresponded to a higher risk of death during the first semester (adjusted ratio of odds-ratios 1.56, 95% CI 1.34-1.81) both inside (1.27, 1.02-1.58) and outside the ICU/IMCU (1.98, 1.57-2.5), with a significant learning effect during the second semester compared to the first (0.76, 0.58-0.99). CONCLUSION Significant excess mortality essentially occurred outside of the ICU/IMCU, suggesting that access of surgical patients to critical care was limited.
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19
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Waldman R, Kaplan H, Leitman IM. Were surgical outcomes for acute appendicitis impacted by the COVID-19 pandemic? BMC Surg 2023; 23:43. [PMID: 36823569 PMCID: PMC9948783 DOI: 10.1186/s12893-023-01930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare systems throughout the world. We examine whether appendectomy outcomes in 2020 and 2021 were affected by the pandemic. METHODS We conducted a retrospective cohort study of 30-day appendectomy outcomes using the ACS-NSQIP database from 2019 through 2021. Logistic regression and linear regression analyses were performed to create models of post-operative outcomes. RESULTS There were no associations between the time period of surgery and death, readmission, reoperation, deep incisional SSI, organ space SSI, sepsis, septic shock, rate of complicated appendicitis, failure to wean from the ventilator, or days from admission to operation. During the first 21 months of the pandemic (April 2020 through December 2021), there was a decreased length of hospital stay (p = 0.016), increased operative time (p < 0.001), and increased likelihood of laparoscopic versus open surgery (p < 0.001) in compared to 2019. CONCLUSIONS There were minimal differences in emergent appendectomy outcomes during the first 21 months of the pandemic when compared to 2019. Surgical systems in the US successfully adapted to the challenges presented by the COVID-19 pandemic.
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Affiliation(s)
- Rachel Waldman
- grid.59734.3c0000 0001 0670 2351Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
| | - Harrison Kaplan
- grid.59734.3c0000 0001 0670 2351Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
| | - I. Michael Leitman
- grid.59734.3c0000 0001 0670 2351Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
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Mocanu V, Verhoeff K, Dang J, Birch DW, Karmali S, Switzer NJ. Post-Operative but Not Pre-Operative COVID-19 Predicts Serious Complications and Mortality Following Elective Bariatric Surgery. Obes Surg 2023; 33:1202-1210. [PMID: 36808387 PMCID: PMC9938678 DOI: 10.1007/s11695-023-06506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE We sought to characterize the prevalence and subsequent impact of pre- and post-operative COVID-19 diagnosis on bariatric surgery outcomes. COVID-19 has transformed surgical delivery, yet little is known regarding its implications for bariatric surgery. MATERIALS AND METHODS The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database was evaluated with three cohorts described: those diagnosed with COVID-19 pre-operatively (PRE), post-operatively (POST), and those without a peri-operative COVID-19 (NO) diagnosis. Pre-operative COVID-19 was defined as COVID-19 within 14 days prior to the primary procedure while post-operative COVID-19 infection was defined as COVID-19 within 30 days after the primary procedure. RESULTS A total of 176,738 patients were identified, of which 174,122 (98.5%) had no perioperative COVID-19, 1364 (0.8%) had pre-operative COVID-19, and 1252 (0.7%) had post-operative COVID-19. Patients who were diagnosed with COVID-19 post-operatively were younger than other groups (43.0 ± 11.6 years NO vs 43.1 ± 11.6 years PRE vs 41.5 ± 10.7 years POST; p < 0.001). Pre-operative COVID-19 was not associated with serious complications or mortality after adjusting for comorbidities. Post-operative COVID-19, however, was among the greatest independent predictors of serious complications (OR 3.5; 95% CI 2.8-4.2; p < 0.0001) and mortality (OR 5.1; 95% CI 1.8-14.1; p = 0.002). CONCLUSIONS Pre-operative COVID-19 within 14 days of surgery was not significantly associated with either serious complications or mortality. This work provides evidence that a more liberal strategy which employs early surgery after COVID-19 infection is safe as we aim to reduce the current bariatric surgery case backlog.
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Affiliation(s)
- Valentin Mocanu
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Dvorkin Lounge Mailroom 2G2, 8440 112 St. NW, EdmontonAlberta, T6G 2B7, Canada.
| | - Kevin Verhoeff
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Dvorkin Lounge Mailroom 2G2, 8440 112 St. NW, EdmontonAlberta, T6G 2B7 Canada
| | - Jerry Dang
- grid.17089.370000 0001 2190 316XDepartment of Surgery, University of Alberta, Edmonton, AB Canada
| | - Daniel W. Birch
- grid.416087.c0000 0004 0572 6214Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB Canada
| | - Shahzeer Karmali
- grid.416087.c0000 0004 0572 6214Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB Canada
| | - Noah J. Switzer
- grid.416087.c0000 0004 0572 6214Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB Canada
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21
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Lescinska AM, Sondore E, Ptasnuka M, Mukans M, Plaudis H. The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020295. [PMID: 36837497 PMCID: PMC9966030 DOI: 10.3390/medicina59020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.
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Affiliation(s)
- Anna Marija Lescinska
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
- Correspondence: ; Tel.: +371-29258517
| | - Elza Sondore
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Margarita Ptasnuka
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Maksims Mukans
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Haralds Plaudis
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
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Neumaier M, Thirukumaran C, Ramirez G, Ricciardi B. Heightened 30-Day Postoperative Complication Risk Persists After COVID-19 Infection. World J Surg 2023; 47:40-49. [PMID: 36201028 PMCID: PMC9540151 DOI: 10.1007/s00268-022-06767-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current literature describing the riskiness of operating on actively infected COVID-19 patients far outnumbers that on the risk of operating on recovered patients. The purpose of this study was to analyze a single, tertiary referral center experience regarding postoperative complications and readmissions in COVID-19-recovered patients versus COVID-19-naïve (never previously infected) patients undergoing elective and emergency surgery across all surgical subspecialties. METHODS All PCR positive COVID-19 patients that underwent a surgical procedure between February 1, 2020, and November 1, 2020, were included in the COVID-positive cohort. These patients were then matched to COVID-naïve controls that underwent similar procedures within the same time frame. Primary outcomes included 30-day postoperative complications as well as 90-day readmissions. Multivariable analyses were also performed. RESULTS 112 COVID-positive patients met inclusion criteria and were all matched to COVID-naïve controls. 76 patients (68%) underwent surgery > 30 days from their COVID diagnosis. COVID-positive patients were at significantly higher risk of 30-day complications compared to the COVID-naïve cohort (22% versus 8%, respectively; p < 0.01). Multivariable analyses found ambulatory/asymptomatic infections, undergoing surgery between 30 and 120 days from diagnosis, initial presentation to the emergency department and elevated ASA scores to be significantly associated with 30-day complications. No differences were found for 90-day readmissions. CONCLUSION Patients with previous COVID-19 infections carry a higher perioperative risk profile for 30-day complications compared to COVID-naïve counterparts in unvaccinated populations.
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Affiliation(s)
- Mackenzie Neumaier
- Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY, USA.
| | - Caroline Thirukumaran
- grid.16416.340000 0004 1936 9174Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY USA
| | - Gabriel Ramirez
- grid.16416.340000 0004 1936 9174Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY USA
| | - Benjamin Ricciardi
- grid.16416.340000 0004 1936 9174Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY USA
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Bernhard L, Amalanesan AF, Baumann O, Rothmeyer F, Hafner Y, Berlet M, Wilhelm D, Knoll A. Mobile service robots for the operating room wing: balancing cost and performance by optimizing robotic fleet size and composition. Int J Comput Assist Radiol Surg 2023; 18:195-204. [PMID: 36088614 PMCID: PMC9464430 DOI: 10.1007/s11548-022-02735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Integrating fleets of mobile service robots into the operating room wing (OR wing) has the potential to help overcome staff shortages and reduce the amount of dull or unhealthy tasks for humans. However, the OR wing has been little studied in this regard and the requirements for realizing this vision have not yet been fully identified. This includes fundamental aspects such as fleet size and composition, which we have now studied comprehensively for the first time. METHODS Using simulation, 150 different scenarios with varying fleet compositions, robot speeds and workloads were studied for a setup based on a real-life OR wing. The simulation included battery recharging cycles and queueing due to shared resources. RESULTS For all simulated scenarios we report results regarding total duration of execution, average task response times and fleet utilization. The relationship between these performance measures and global scenario parameters-such as fleet size, fleet composition, robot velocity and the number of operating rooms to be served-is visualized. CONCLUSION Our simulation-based studies have proven to be a valuable tool for individualized dimensioning of mobile robotic fleets, based on realistic workflows and environmental models. Thereby, important implications for future developments of mobile robots have been identified and a basis of decision-making regarding fleet size, fleet composition, robot capabilities and robot velocities can be provided. Due to costs, space limitations and safety requirements, these aspects must be carefully considered to successfully integrate mobile robotic technology into real-world OR wing environments.
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Affiliation(s)
- Lukas Bernhard
- Research Group MITI, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | | | - Oskar Baumann
- Chair of Robotics, Artificial Intelligence and Real-Time Systems, Technical University of Munich, Munich, Germany
| | - Florian Rothmeyer
- Chair of Materials Handling, Material Flow, Logistics, Technical University of Munich, Munich, Germany
| | - Yannic Hafner
- Chair of Materials Handling, Material Flow, Logistics, Technical University of Munich, Munich, Germany
| | - Maximilian Berlet
- Research Group MITI, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group MITI, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alois Knoll
- Chair of Robotics, Artificial Intelligence and Real-Time Systems, Technical University of Munich, Munich, Germany
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24
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Management of Laryngotracheal Trauma During the COVID 19 Pandemic: Our Experience. Indian J Otolaryngol Head Neck Surg 2022:1-10. [PMCID: PMC9638418 DOI: 10.1007/s12070-022-03265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022] Open
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25
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García AF, Ángel‐Isaza AM, Chica J, Estrada DE, Vargas‐Morales CA, Revelo‐Noguera J, Morell T, Gómez JA, Rodríguez Holguín F, Umaña M, Serna JJ, Carvajal S. Lung ultrasound as a screening tool for SARS-CoV-2 infection in surgical patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1271-1278. [PMID: 36200639 PMCID: PMC9874590 DOI: 10.1002/jcu.23358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of lung ultrasound (LUS) in screening for SARS-CoV-2 infection in patients requiring surgery. METHODS Patients underwent a LUS protocol that included a scoring system for screening COVID-19 pneumonia as well as RT-PCR test for SARS-CoV-2. The receiver operator characteristic (ROC) curve was determined for the relationship between LUS score and PCR test results for COVID-19. The optimal threshold for the best discrimination between non-COVID-19 patients and COVID-19 patients was calculated. RESULTS Among 203 patients enrolled (mean age 48 years; 82 males), 8.3% were COVID-19-positive; 4.9% were diagnosed via the initial RT-PCR test. Of the patients diagnosed with SARS-CoV-2, 64.7% required in-hospital management and 17.6% died. The most common ultrasound findings were B lines (19.7%) and a thickened pleura (19.2%). The AUC of the ROC curve of the relationship of LUS score with a cutoff value >8 versus RT-PCR test for the assessment of SARS-CoV-2 pneumonia was 0.75 (95% CI 0.61-0.89; sensitivity 52.9%; specificity 91%; LR (+) 6.15, LR (-) 0.51). CONCLUSION The LUS score in surgical patients is not a useful tool for screening patients with potential COVID-19 infection. LUS score shows a high specificity with a cut-off value of 8.
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Affiliation(s)
| | | | - Julian Chica
- Clinical Research Center, Centro de Investigaciones ClínicasFundación Valle del LiliCaliColombia
| | | | | | | | - Tatiana Morell
- Department of Emergency MedicineFundación Valle del LiliCaliColombia
| | | | | | - Mauricio Umaña
- Department of Emergency MedicineFundación Valle del LiliCaliColombia
| | | | - Sandra Carvajal
- Department of Emergency MedicineFundación Valle del LiliCaliColombia
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26
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González-Díaz A, Gil-Moradillo J, Rosillo-Ramírez N, Varela-Rodríguez C, Rodríguez-Antolín A, Tejido-Sánchez Á. Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area. J Healthc Qual Res 2022; 37:382-389. [PMID: 35624026 PMCID: PMC9069227 DOI: 10.1016/j.jhqr.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze surgical safety through postoperative COVID-19 incidence and mortality at the urology department of a tertiary hospital located in Madrid (Spain). METHODS Observational, prospective study including all patients undergoing urological surgery from 1st March 2020 to 28th February 2021. According to the hospital organization and local epidemiological situation we delimitate three epidemic waves. A set of screening and protective measures was applied from 4th May onwards. Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were collected. Telephone follow-up was performed at least 3 weeks after hospital discharge. RESULTS 940 urological surgeries were performed, 12 of them had to be rescheduled due to active or recent SARS-CoV-2 infection identified by the screening protocol. Thirty-one patients developed COVID-19 (3.3% incidence) and 7 died (22.6% mortality). The average time to onset of symptoms was 62.6 days after discharge, being 25 cases attributable to community transmission. The remaining 6 cases, due to in-hospital transmission, had worse outcomes. Five of them were identified during the first wave, especially when no preoperative PCR was obtained. In contrast, during the second and third waves, fewer and milder cases were diagnosed, with just 1 in-hospital transmission among 857 urological patients. CONCLUSIONS After implementing complete protective measures, postoperative in-hospital COVID-19 cases almost disappeared, even during the second and third waves. Most of the cases were due to community transmission and thus driven by the general epidemiological situation. While hospitals follow recommendations to avoid COVID-19 infection, urological surgery remains safe and can be maintained.
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Affiliation(s)
- A González-Díaz
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain.
| | - J Gil-Moradillo
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - N Rosillo-Ramírez
- Preventive Medicine Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - C Varela-Rodríguez
- Quality Healthcare Unit, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - A Rodríguez-Antolín
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - Á Tejido-Sánchez
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
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27
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Masterson Creber R. Time to Tune In: Early Career Nurses Are at a Tipping Point. J Cardiovasc Nurs 2022; 37:512-514. [PMID: 35319528 PMCID: PMC9492803 DOI: 10.1097/jcn.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ruth Masterson Creber
- Ruth Masterson Creber, PhD, RN, FAHA, FAAN Chair, CVSN Early Career Committee, Department of Population Health Sciences, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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28
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Sugita A, Inagaki FF, Takemura N, Nakamura M, Ito K, Mihara F, Yamamoto K, Morioka S, Kokudo N. Liver resection in a patient with persistent positive PCR test for coronavirus disease 2019 (COVID-19): a case report. Surg Case Rep 2022; 8:200. [PMID: 36264514 PMCID: PMC9583064 DOI: 10.1186/s40792-022-01553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perioperative mortality rate is high in patients with coronavirus disease 2019 (COVID-19), and infection control measures for medical care providers must be considered. Therefore, the timing for surgery in patients recovering from COVID-19 is difficult. CASE PRESENTATION A 65-year-old man was admitted to a hospital with a diagnosis of moderate COVID-19. He was transferred to our hospital because of risk factors, including heavy smoking history, type 2 diabetes mellitus, and obesity (BMI 34). Vital signs on admission were a temperature of 36.1 °C, oxygen saturation > 95% at rest, and 94% on exertion with 3 L/min of oxygen. Chest computed tomography (CT) showed bilateral ground-glass opacities, predominantly in the lower lungs. Contrast-enhanced abdominal CT incidentally revealed a liver tumor with a diameter of 80 mm adjacent to the middle hepatic vein, which was diagnosed as hepatocellular carcinoma (HCC). After being administered baricitinib, remdesivir, dexamethasone, and heparin, the patient's COVID-19 pneumonia improved, his oxygen demand resolved, and he was discharged on day 13. Furthermore, the patient was initially scheduled for hepatectomy 8 weeks after the onset of COVID-19 following a discussion with the infection control team. However, 8 weeks after the onset of illness, a polymerase chain reaction (PCR) test was performed on nasopharyngeal swab fluid, which was observed to be positive. The positive results persisted till 10 and 11 weeks after onset. Both Ct values were high (≥ 31) out of 45 cycles, with no subjective symptoms. Since we determined that he was no longer contagious, surgery was performed 12 weeks after the onset of COVID-19. Notably, medical staff wearing personal protective equipment performed extended anatomical resection of the liver segment 8 ventral area in a negative-pressure room. The patient had a good postoperative course, with no major complications, including respiratory complications, and was discharged on postoperative day 14. Finally, none of the staff members was infected with COVID-19. CONCLUSIONS We reported a case regarding the timing of surgery on a patient with persistently positive PCR test results after COVID-19, along with a literature review.
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Affiliation(s)
- Akiho Sugita
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan ,grid.45203.300000 0004 0489 0290National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan
| | - Fuyuki F. Inagaki
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Nobuyuki Takemura
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Mai Nakamura
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Kyoji Ito
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Fuminori Mihara
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Kei Yamamoto
- grid.45203.300000 0004 0489 0290National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan
| | - Shinichiro Morioka
- grid.45203.300000 0004 0489 0290National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan
| | - Norihiro Kokudo
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
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Impact of the COVID-19 Pandemic on Neurosurgical Transfers: A Single Tertiary Center Study. World Neurosurg 2022; 166:e915-e923. [PMID: 35944857 PMCID: PMC9356759 DOI: 10.1016/j.wneu.2022.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention. METHODS A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed. RESULTS A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001). CONCLUSION The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.
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Zhang WJ, Zou FL, Hu DX, Luo HL, Wu LD, Hu JL. SARS-CoV-2: Operating room management strategies and recommendations. Front Med (Lausanne) 2022; 9:933799. [PMID: 36117977 PMCID: PMC9478436 DOI: 10.3389/fmed.2022.933799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022] Open
Abstract
Since the outbreak of SARS-CoV-2/COVID-19 in Wuhan, China in 2019, it has rapidly spread to the world, and the number of infections has gradually increased. The hospitalization rate of patients has also gradually increased, which poses a huge challenge to hospitals and medical staff for patients with SARS-CoV-2 requiring surgical treatment. Therefore, avoiding cross-infection in the operating room is an important protective work. The operating room is an important department of the hospital, scientific and reasonable management is particularly important. Therefore, we have put forward corresponding suggestions and strategies for preoperative preparation and evaluation of patients, intraoperative management, postoperative terminal management, and protection of medical staff, and hope that these measures can better prevent and control the infection of SARS-CoV-2 in the operating room.
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Affiliation(s)
- Wen-jun Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Fei-long Zou
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Dong-xia Hu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Hong-liang Luo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Li-dong Wu
- Emergency Department, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Jia-ling Hu
- Emergency Department, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- *Correspondence: Jia-ling Hu,
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Hejazi P, Yousefi S, Hemmati H, Faraji N, Mohammadyari F. Intussusception of the bowel in a young woman: A case report. Clin Case Rep 2022; 10:e6309. [PMID: 36177073 PMCID: PMC9478627 DOI: 10.1002/ccr3.6309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2022] Open
Abstract
Intussusception is a condition in which a segment of the gastrointestinal tract invaginates into the lumen of another segment. Adult intussusception is less common than juvenile intussusception in terms of cause, appearance, and treatment. Because the clinical picture can be quite atypical and difficult to interpret, it is frequently misdiagnosed at first. Herein, we report the case of a previously healthy 23-year-old female patient who presented to the Emergency Department (ED) with acute abdominal pain, vomiting, and diarrhea for 1 day following her last menstrual period. Ileocecal intussusception was discovered throughout the investigation. She was rushed for open abdominal surgery. Meckel's diverticulum was found as a pathologic lead point in the resected specimen, with no evidence of malignancy. Although intussusception is rare in adults, it should be considered in patients who have nonspecific stomach pain.
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Affiliation(s)
- Peyman Hejazi
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of MedicalRashtIran
| | - Saeed Yousefi
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Hossein Hemmati
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of MedicalRashtIran
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Niloofar Faraji
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of MedicalRashtIran
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O'Glasser AY, Schenning KJ. COVID-19 in the perioperative setting: A review of the literature and the clinical landscape. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 28:100272. [PMID: 35783339 PMCID: PMC9236621 DOI: 10.1016/j.pcorm.2022.100272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has dramatically affected societies and healthcare systems around the globe. The perioperative care continuum has also been under significant strain due to the pandemic-tasked with simultaneously addressing surgical strains and backlogs, infection prevention strategies, and emerging data regarding significantly higher perioperative risk for COVID-19 patients and survivors. Many uncertainties persist regarding the perioperative risk, assessment, and management of COVID-19 survivors-and the energy to catch up on surgical backlogs must be tempered with strategies to continue to mitigate COVID-19 related perioperative risk. Here, we review the available data for COVID-19-related perioperative risk, discuss areas of persistent uncertainty, and empower the perioperative teams to pursue evidence-based strategies for high quality, patient-centered, team-based care as we enter the third year of the COVID-19 pandemic.
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Key Words
- APSF, anesthesia patient safety foundation
- ARDS, acute respiratory distress syndrome
- ASA PS, American society of anesthesiologists physical status
- ASA, American society of anesthesiologists
- ASC, ambulatory surgery center
- Anesthesiology
- COVID-19
- ECMO, extracorporeal membrane oxygenation
- NNV, number needed to vaccinate
- PASC, post-acute sequelae of SARS-CoV-2
- PEM, post-exertional malaise
- PICS, post-intensive care syndrome
- POTS, postural orthostatic tachycardia syndrome
- PPE, personal protective equipment
- PTSD, post-traumatic stress disorder
- Perioperative medicine
- RCRI, revised cardiac risk index
- SARS-CoV-2
- Surgical risk
- VTE, venous thromboembolism
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Affiliation(s)
- Avital Y O'Glasser
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CHH2 8008, Portland, OR 97239, United States
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, United States
| | - Katie J Schenning
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, United States
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Surgical Outcomes During the First Year of the COVID-19 Pandemic. Surg Laparosc Endosc Percutan Tech 2022; 32:517-518. [PMID: 35960699 PMCID: PMC9524518 DOI: 10.1097/sle.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S, Thomas V, Kluyts HL, Peden CJ, de Boer HD, Brindle M, Francis NK, Nelson G, Gustafsson UO, Ljungqvist O. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg 2022; 46:1826-1843. [PMID: 35641574 PMCID: PMC9154207 DOI: 10.1007/s00268-022-06587-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care. METHODS The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS® Society and eight members from LMIC's. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592-695, Nelson et al in Int J Gynecol Cancer 29(4):651-668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC's and LMIC's were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC's. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC's and determined through discussions and consensus. RESULTS In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline. CONCLUSIONS These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC's.
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Affiliation(s)
- Ravi Oodit
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Bruce M. Biccard
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Eugenio Panieri
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Adrian O. Alvarez
- Anesthesia Department, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Peron, 4190, C1199ABB Beunos Aires, Argentina
| | - Marianna R. S. Sioson
- Head Section of Medical Nutrition, Department of Medicine and ERAS Team, The Medical City, Ortigas Avenue, Manila, Metro Manila Philippines
| | - Salome Maswime
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Viju Thomas
- Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Francie Van Zyl Drive, Parow, Cape Town, Western Cape South Africa
| | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Medunsa, Molotlegi Street, P.O. Box 60, Ga-Rankuwa, Pretoria, 0204 Gauteng South Africa
| | - Carol J. Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Hans D. de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Mary Brindle
- Cumming School of Medicine, University of Calgary, London, Canada
- Alberta Children’s Hospital, Calgary, Canada
- Safe Systems, Ariadne Labs, Stockholm, USA
- EQuIS Research Platform, Orebro, Canada
| | - Nader K. Francis
- Division of Surgery and Interventional Science- UCL, Gower Street, London, WC1E 6BT UK
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, 1331 29 St NW, Calgary, AB T2N 4N2 Canada
| | - Ulf O. Gustafsson
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Entrevägen 2, 19257 Stockholm, Danderyd Sweden
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, 701 85 Örebro, Sweden
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Koranne M, Patil PD, Dhamnaskar SS. Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt. Surg J (N Y) 2022; 8:e192-e198. [PMID: 36004007 PMCID: PMC9395240 DOI: 10.1055/s-0042-1755619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022] Open
Abstract
Abstract
Introduction On March 11, 2020, the novel coronavirus disease 2019 (COVID-19) was declared as a pandemic. General surgeons provide care to COVID-19 positive patients requiring emergency surgeries and hence are exposed to the virus. Surgery on COVID-19-positive patient itself is a major risk factor for surgeon to contract COVID-19 infection. Noticeably, there is no data regarding number of surgeons who have contracted COVID-19 after operating on COVID-19-positive patients. Hence, the aim of this study was to find out the exact incidence of COVID-19 among surgeons operating on COVID-19-positive patients and to analyze the impact of safety measures practiced by us.
Methodology The study was conducted in a tertiary care center in Mumbai. It was a retrospective observational study with duration of 5 months from May 1, 2020, to September 30, 2020. Only those surgeons (faculty and resident doctors) were included who performed surgeries on COVID-19-positive patients (diagnosed by reverse-transcription polymerase chain reaction [RT-PCR] test) and gave consent for participation. As an institutional protocol, all patients undergoing surgery were tested by RT-PCR test (irrespective of chest X-ray or symptoms). Nasopharyngeal swabs for COVID-19 disease were collected prior to procedure but in some of these, results came after surgery. Still such patients were included in this study. Irrespective of COVID-19 status, same precautions were taken for all surgeries. The details of the patients like date of surgery, age, sex, surgery performed, duration of surgery, type of anesthesia used, and operating surgeon were noted from operation room (OR) register. Details of surgeons (faculty and resident doctors) who fulfilled inclusion criteria were noted by interview in terms of their demographic parameters, such as age, sex, designation, experience in years after completing postgraduation, comorbidities, whether they ever contracted COVID-19 (if yes, date), and safety measures practiced (yes, no, or cannot recollect). Patient was assumed to be the source only if the surgeon contracted COVID-19 within 14 days of surgery.
Results A total of 34 surgeons (7 faculty and 27 residents) conducted 41 surgeries on COVID-19-positive patients during the study period. All of them gave consent for participation in the study. More than one surgeon was involved in a particular surgery. Hence, there were 78 occasions (faculty during 16 occasions and resident doctors on 62 occasions) when surgeons were at risk to contract COVID-19 while operating on patients (n = 78). These surgeries had similar/comparable risk of COVID-19 exposure to surgeons and procedures with excessive exposure risk like airway procedures did not happen during the study period. The mean age of surgeon was 27.92 years (n = 78, standard deviation = 5.71) and median experience of faculty after completion of postgraduate degree was 7 years (n = 16, interquartile range [IQR] = 1.25–11.0). Only one faculty had comorbidity (diabetes mellitus). Duration of surgeries ranged from 50 to 420 minutes with median being 190 minutes (n = 41, IQR = 120–240). Only one surgeon (male faculty) contracted COVID-19 within 14 days of surgery (1.3% incidence, n = 78), a total of seven surgeons contracted COVID-19 during study period but not within 14 days of surgery (source other than patient operated) and all remaining surgeons were asymptomatic throughout the study period. The surgeon who contracted COVID-19 (within 14 days) performed surgery for 260 minutes and under general anesthesia. All the surgeons followed standard steps of donning and doffing, used personal protective equipment (PPE) body cover, shoe cover, hood, double pair of gloves, and N-95 masks at all times (n = 78). Intubation box was used in 100% cases of general anesthesia (n = 19). Fogging of OR after each surgery and interval of 20 minutes between surgeries was followed in 100% cases. Also, patient was wearing mask at all possible times and anesthetist and support staff used PPE during all surgeries. Hence the relationship between COVID-19 status and these safety measures cannot be assessed. Goggles and face shields were not used on 88.5% (n = 78) and 93.2% (n = 73, because five surgeons could not recollect whether they used face shields or not) occasions, respectively. Also, immediate shower after surgery was not taken on 93.6% occasions (n = 78). The surgeon who contracted COVID-19 had neither used goggles nor face shield. Also, he did not take shower immediately after surgery. However, there was no significant association between use of goggles, face shields, or shower after surgery and contraction of COVID-19 after operating patients (Fisher's exact p = 1.000). Air conditioner was switched-off only in 7.3% surgeries (n = 41). Smoke evacuator (cautery with attached suction) was not used in 97.6% cases. Clinical documentation (handling of patient's files) was done outside OR in only 17.1% surgeries (n = 41). However, there was no significant association between these safety measures and contraction of COVID-19 (Fisher's exact p = 1.000). General anesthesia was used in 19 surgeries (46.3%) while spinal anesthesia in 16 surgeries (39%), local anesthesia in 5 surgeries (12.2%), and total intravenous anesthesia (TIVA) in one surgery (2.4%). However, there was no significant association between type of anesthesia given during surgery and contraction of COVID-19 after operating on patients with Fisher's exact p-value of 1.000.
Conclusion Even though safety measures, like goggles, face shield, switching-off of air conditioner, use of smoke evacuator, and shower, immediately after surgery were not practiced in majority of cases, surgeon positivity rate was significantly less. Also, there was no use of negative pressure in OR. Hence, their significance becomes questionable. Although adopting all universal safety measures is in everyone's best interest, it is seldom cost-effective. To reduce resource exhaustion, especially in a pandemic situation, the use of various safety measures and staff must be balanced. Use and promotion of unnecessary safety measures leads to added health care costs and fear among health care workers in case of unavailability. Even though our study has a small sample size and has its own limitations, it can guide future studies to strengthen recommendations and reduce health care costs. This will also help in future epidemics/pandemics.
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Affiliation(s)
- Mandar Koranne
- Department of General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Pratik D. Patil
- Department of General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Suchin S. Dhamnaskar
- Department of General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Bekniyazova AZ, Kadralinova A, Konkayeva ME, Yeltayeva AA, Konkayev AK. Case Report: Complex Treatment Using Vibroacoustic Therapy in a Patient With Co-Infection and COVID-19. Front Med (Lausanne) 2022; 9:893306. [PMID: 35746948 PMCID: PMC9210955 DOI: 10.3389/fmed.2022.893306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
The present report highlights a case of successful treatment of a 59-year-old patient who experienced pain, swelling, hyperemia, the presence of a wound of the right knee joint, impaired function of the right lower limb, weakness, fatigue, and labored breathing. Sepsis was detected in the patient as a result of periprosthetic infection with concomitant severe COVID-19. The patient was admitted to the hospital for 59 days, with 57 days of treatment of the patient at the intensive care unit. A therapy of multiple organ failure involved complex treatment using antiviral and combined antibiotic therapy, taking into account the sensitivity of the pathogen to antibiotics; glucocorticoid therapy; anticoagulant therapy; the concept of non-invasive ventilation; and vibroacoustic pulmonary therapy as a method of physiotherapy as well. An integrated approach using a vibroacoustic device in the therapy of the patient with sepsis due to periprosthetic infection with concomitant coronavirus infection had a positive effect despite the lack of etiological treatment against the COVID-19.
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Affiliation(s)
- Assema Zh. Bekniyazova
- Department of Anesthesiology and Intensive Care, Astana Medical University, Nur-Sultan, Kazakhstan
- *Correspondence: Assema Zh. Bekniyazova, , orcid.org/0000-0002-3117-0294
| | - Assiya Kadralinova
- Department of Anesthesiology and Intensive Care, Astana Medical University, Nur-Sultan, Kazakhstan
- Department of Anesthesiology and Intensive Care, The National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov, Nur-Sultan, Kazakhstan
| | - Maiya E. Konkayeva
- Department of Anesthesiology and Intensive Care, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Aigerim A. Yeltayeva
- Department of Anesthesiology and Intensive Care, Astana Medical University, Nur-Sultan, Kazakhstan
- Department of Anesthesiology and Intensive Care, The National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov, Nur-Sultan, Kazakhstan
| | - Aidos K. Konkayev
- Department of Anesthesiology and Intensive Care, Astana Medical University, Nur-Sultan, Kazakhstan
- Department of Anesthesiology and Intensive Care, The National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov, Nur-Sultan, Kazakhstan
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Temmesfeld MJ, Gorzkowska-Sobas AA, Hedlund K, Øyen MØ, Kanten L, Grant P, Jakobsen RB. Surgical helmets can be converted into efficient disinfectable powered air-purifying respirators. Am J Infect Control 2022; 50:624-630. [PMID: 34958857 DOI: 10.1016/j.ajic.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Filtering facepiece respirators often fail to provide sufficient protection due to a poor fit. Powered air-purifying respirators (PAPRs) are not designed for healthcare personnel, and are challenging to disinfect. Surgical helmets (SH) are available in many United States hospitals but do not provide respiratory protection. Several modifications to SH have been suggested, but none are sufficiently compliant with safety and efficiency standards. The purpose of this investigation was the development of a filter adaptor, which converts SHs into efficient, safe, and disinfectable PAPRs. METHODS Four critical features were investigated close to regulatory requirements: total inward leakage of particles, CO2 concentrations, intra-helmet differential pressure, and automated disinfection. RESULTS The average total inward leakage in the 2 independent tests were 0.005% and 0.01%. CO2 concentrations were lower than in the original SH. The modification generates a positive differential pressure. The filter's performance was not compromised after 50 cycles in a sterilization machine. DISCUSSION The modified SH provides several hundred times better protection than FFP-3 masks. CONCLUSIONS Surgical helmets can be modified into safe, efficient, and disinfectable PAPRs, suitable for HCP and the operating room in particular. They can play a role in the preparedness for upcoming events requiring efficient respiratory protection.
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Affiliation(s)
- Max Joachim Temmesfeld
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway.
| | | | | | | | - Lars Kanten
- Department of Sterile Supplies, Akershus University Hospital, Lørenskog, Norway
| | - Peter Grant
- Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gotehnburg, Sweden; Lovisenberg Diaconal Hospital, Nydalen, Oslo, Norway
| | - Rune B Jakobsen
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway
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Grosser R, Romero-Velez G, Pereira X, Moran-Atkin E, Choi J, Camacho DR. Postoperative pneumonia after bariatric surgery during the COVID-19 pandemic: A NSQIP study. Surg Obes Relat Dis 2022; 18:1239-1245. [PMID: 35843783 PMCID: PMC9212841 DOI: 10.1016/j.soard.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 11/13/2022]
Abstract
Background During the COVID-19 pandemic, surgical centers had to weigh the benefits and risks of conducting bariatric surgery. Obesity increases the risk of developing severe COVID-19 infections, and therefore, bariatric surgery is beneficial. In contrast, surgical patients who test positive for COVID-19 have higher mortality rates. Objective This study investigates the national prevalence of postoperative pneumonia during the COVID-19 pandemic in the bariatric surgery population. Setting The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Methods This is a cross-sectional study using the ACS-NSQIP database. The population of concern included patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Information was extracted on rate of postoperative pneumonia and other 30-day complications between 2018 and 2020. Results All baseline characteristics were similar among patients who underwent bariatric surgery between 2018 and 2020. However, there was a 156% increase in postoperative pneumonia in 2020 compared with the previous year. Furthermore, despite the similar postoperative complication rates across the years, there was a statistically significant increase in all-cause mortality in 2020. The multivariate analysis showed that having surgery in 2020 was a statistically significant risk factor for pneumonia development postoperatively. Conclusions This study showed a statistically significant increase in the prevalence of postoperative pneumonia during the COVID-19 pandemic among bariatric surgery patients. Surgical centers must continuously evaluate the risks associated with healthcare-associated exposure to COVID-19 and weigh the benefits of bariatric surgery.
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Further Divided Gender Gaps in Research Productivity and Collaboration during the COVID-19 Pandemic: Evidence from Coronavirus-related Literature. J Informetr 2022; 16:101295. [PMID: 35529705 PMCID: PMC9068670 DOI: 10.1016/j.joi.2022.101295] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/21/2022]
Abstract
Based on publication data on coronavirus-related fields, this study applies a difference in differences approach to explore the evolution of gender inequalities before and during the COVID-19 pandemic by comparing the differences in the numbers and shares of authorships, leadership in publications, gender composition of collaboration, and scientific impacts. We find that, during the pandemic: (1) females’ leadership in publications as the first author was negatively affected; (2) although both females and males published more papers relative to the pre-pandemic period, the gender gaps in the share of authorships have been strengthened due to the larger increase in males’ authorships; (3) the share of publications by mixed-gender collaboration declined; (4) papers by teams in which females play a key role were less cited in the pre-pandemic period, and this citation disadvantage was exacerbated during the pandemic; and (5) gender inequalities regarding authorships and collaboration were enhanced in the initial stage of COVID-19, widened with the increasing severity of COVID-19, and returned to the pre-pandemic level in September 2020. This study shows that females’ lower participation in teams as major contributors and less collaboration with their male colleagues also reflect their underrepresentation in science in the pandemic period. This investigation significantly deepens our understanding of how the pandemic influenced academia, based on which science policies and gender policy changes are proposed to mitigate the gender gaps.
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Liang T, Chamdawala HS, Tay ET, Chao J, Waseem M, Lee H, Mortel D, Agoritsas K, Teo HO, Meltzer JA. Pediatric emergency care in New York City during the COVID-19 pandemic shutdown and reopening periods. Am J Emerg Med 2022; 56:137-144. [PMID: 35397354 PMCID: PMC8966116 DOI: 10.1016/j.ajem.2022.03.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022] Open
Abstract
Objective New York City (NYC) is home to the largest public healthcare system in the United States and was an early epicenter of coronavirus disease 2019 (COVID-19) infections. This system serves as the safety net for underserved and marginalized communities disproportionately affected by the pandemic. Prior studies reported substantial declines in pediatric emergency department (ED) volume during the initial pandemic surge, but few describe the ongoing impact of COVID-19 throughout the year. We evaluated the characteristics of pediatric ED visits to NYC public hospitals during the pandemic lockdown and reopening periods of 2020 compared to the prior year. Methods Retrospective cross-sectional analysis of pediatric ED visits from 11 NYC public hospitals from January 2019–December 2020. Visit demographics, throughput times, and diagnosis information during the early (3/7/20–6/7/20) and late (6/8/20–12/31/20) pandemic periods coinciding with the New York State of emergency declaration (3/7/20) and the first reopening date (6/7/20) were compared to similar time periods in 2019. Findings were correlated with key pandemic shutdown and reopening events. Results There was a 47% decrease in ED volume in 2020 compared to 2019 (125,649 versus 238,024 visits). After reopening orders began in June 2020, volumes increased but peaked at <60% of 2019 volumes. Admission rates, triage acuity, and risk of presenting with a serious medical illness were significantly higher in 2020 versus 2019 (P < 0.001). Time-to-provider times decreased however provider-to-disposition times increased during the pandemic (P < 0.001). Infectious and asthma diagnoses declined >70% during the pandemic in contrast to the year prior. After reopening periods began, penetrating traumatic injuries significantly increased compared to 2019 [+34%, Relative Risk: 3.2 (2.6, 3.8)]. Conclusions NYC public hospitals experienced a sharp decrease in pediatric volume but an increase in patient acuity during both the initial pandemic surge and through the reopening periods. As COVID-19 variants emerge, the threat of the current pandemic expanding remains. Understanding its influence on pediatric ED utilization can optimize resource allocation and ensure equitable care for future surge events.
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Affiliation(s)
- Tian Liang
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York University Langone Health, 550 1st Ave, New York, NY 10016, United States of America; New York City Health + Hospitals, Bellevue, 462 1st Ave, New York, NY 10016, United States of America.
| | - Haamid S Chamdawala
- Department of Pediatrics, Division of Emergency Medicine, New York City Health + Hospitals, Jacobi, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Ee Tein Tay
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York University Langone Health, 550 1st Ave, New York, NY 10016, United States of America; New York City Health + Hospitals, Bellevue, 462 1st Ave, New York, NY 10016, United States of America
| | - Jennifer Chao
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York City Health + Hospitals, Kings County, 451 Clarkson Ave, Brooklyn, NY 11203, United States of America; State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America
| | - Muhammad Waseem
- Department of Emergency Medicine, New York City Health + Hospitals, Lincoln, 234 E 149th St, Bronx, NY 10451, United States of America; Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States of America
| | - Horton Lee
- Department of Pediatrics, New York City Health + Hospitals, Elmhurst, 79-01 Broadway, Queens, NY 11373, United States of America; Division of Emergency Medicine and Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, United States of America
| | - David Mortel
- Department of Emergency Medicine, New York City Health + Hospitals, Harlem, 506 Lenox Ave, New York, NY 10037, United States of America; Columbia University College of Physicians & Surgeons, 630 W 168th St, New York, NY 10032, United States of America
| | - Konstantinos Agoritsas
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York City Health + Hospitals, Kings County, 451 Clarkson Ave, Brooklyn, NY 11203, United States of America; State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America
| | - Hugo O Teo
- New York City Health + Hospitals, 125 Worth St, New York, NY 10013, United States of America
| | - James A Meltzer
- Department of Pediatrics, Division of Emergency Medicine, New York City Health + Hospitals, Jacobi, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
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Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis. World J Surg 2022; 46:984-993. [PMID: 35267077 PMCID: PMC8908743 DOI: 10.1007/s00268-022-06503-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/24/2022]
Abstract
Background The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals. Methods Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis. Results 6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI − 196 to − 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001). Conclusions During the COVID-19 pandemic, children’s surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06503-2.
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Singh S, Kishore D, Singh RK. Potential for Further Mismanagement of Fever During COVID-19 Pandemic: Possible Causes and Impacts. Front Med (Lausanne) 2022; 9:751929. [PMID: 35308547 PMCID: PMC8924660 DOI: 10.3389/fmed.2022.751929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/26/2022] [Indexed: 01/01/2023] Open
Abstract
Fever remains an integral part of acute infectious diseases management, especially for those without effective therapeutics, but the widespread myths about "fevers" and the presence of confusing guidelines from different agencies, which have heightened during the coronavirus disease 2019 (COVID-19) pandemic and are open to alternate interpretation, could deny whole populations the benefits of fever. Guidelines suggesting antipyresis for 37.8-39°C fever are concerning as 39°C boosts the protective heat-shock and immune response (humoral, cell-mediated, and nutritional) whereas ≥40°C initiates/enhances the antiviral responses and restricts high-temperature adapted pathogens, e.g., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), strains of influenza, and measles. Urgent attention is accordingly needed to address the situation because of the potential public health consequences of the existence of conflicting guidelines in the public domain. We have in this article attempted to restate the benefits of fever in disease resolution, dispel myths, and underline the need for alignment of national treatment guidelines with that of the WHO, to promote appropriate practices and reduce the morbidity and mortality from infectious diseases, such as COVID-19.
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Affiliation(s)
- Samer Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Dhiraj Kishore
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rakesh K. Singh
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
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Verhoeff K, Mocanu V, Dang J, Wilson H, Switzer NJ, Birch DW, Karmali S. Impact of the COVID-19 pandemic on bariatric surgery in North America – A retrospective analysis of 834,647 patients. Surg Obes Relat Dis 2022; 18:803-811. [PMID: 35474010 PMCID: PMC8933967 DOI: 10.1016/j.soard.2022.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 12/27/2022]
Abstract
Background COVID-19 has transformed surgical care, yet little is known regarding implications for bariatric surgery. Objective We sought to characterize the effect of COVID-19 on bariatric surgery delivery and outcomes. Setting The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 885 centers in North America. Methods The MBSAQIP database was evaluated with 2 cohorts described: the COVID-19 and the pre–COVID-19, with patients receiving surgery in 2020 and 2015–2019, respectively. Yearly operative trends were characterized, and bivariate analysis compared demographics and postoperative outcomes. Multivariable modeling evaluated 30-day readmission, reintervention, and reoperation rates and factors associated with undergoing Roux-en-Y gastric bypass. Results We evaluated 834,647 patients, with 155,830 undergoing bariatric surgery during the 2020 pandemic year. A 12.1% reduction in total cases (177,208 in 2019 versus 155,830 in 2020; P < .001) and 13.8% reduction in cases per center occurred (204.2 cases per center in 2019 versus 176.1 cases per center in 2020; P < .001). Patients receiving bariatric surgery during the pandemic were younger and had fewer co-morbidities. Use of sleeve gastrectomy increased (74.5% versus 72.5%; P < .001), and surgery during COVID-19 was associated with reduced Roux-en-Y gastric bypass procedure selection (odds ratio = .83; 95% CI: .82–.84; P < .001). Length of stay decreased significantly (1.4 ± 1.4 days versus 1.6 ± 1.4 days; P < .001), yet postoperative outcomes were similar. After adjusting for co-morbidities, patients during COVID-19 had decreased 30-day odds of readmission and reintervention and a small increase in odds of reoperation. Conclusion The COVID-19 pandemic dramatically changed bariatric surgery delivery. Further studies evaluating the long-term effects of these changes are warranted.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jerry Dang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hillary Wilson
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel W Birch
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Spooner J, Lawen T, Ory J. Triaging urological surgeries to cope with the coronavirus-19 pandemic. Curr Opin Urol 2022; 32:131-140. [PMID: 34939597 PMCID: PMC8815629 DOI: 10.1097/mou.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus-19 (COVID-19) pandemic has led to strains on hospital resources and difficulties in safely and effectively triaging surgical procedures. In this article, we discuss the important considerations for triaging urologic surgeries during a global pandemic, mitigating factors on how to perform surgeries safely, and general guidelines for specific surgeries. RECENT FINDINGS Many urological procedures have been cut back due to the pandemic, with benign disease states being most affected whereas oncology cases affected least. Current recommendations in urology triage life-threatening conditions, or conditions that may lead to life-threatening ailments as a priority for treatment during the pandemic. Additionally, published recommendations have been put forth recommending all surgical patients be screened for COVID-19 to protect staff, prevent disease dissemination, and to educate patients on worse outcomes that can occur if infected with COVID-19 in the postoperative period. SUMMARY COVID-19 has caused worldwide shortages of healthcare resources and increased the need to ethically triage resources to adequately treat the urologic community. These resource limitations have led to increased wait times and cancellations of many urology surgeries that are considered 'elective'.
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Affiliation(s)
- Jesse Spooner
- Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
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Ghanayem JF, Zakaria AD, Wan Zain WZ, Al-Chalabi MMM. Hospital-Acquired COVID-19 Infection Increases Morbidity and Mortality: A Case Report of Post-Surgical Challenge of Duodenal Ulcer Repair During COVID-19 Era. Cureus 2022; 14:e22646. [PMID: 35371774 PMCID: PMC8962135 DOI: 10.7759/cureus.22646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
Hospital-acquired infections are nosocomially acquired infections that are not present or incubating at the time of admission to a hospital. During the COVID-19 pandemic, many hospitals became sources of the infection, creating a great challenge for health care providers and uninfected patients who visited these hospitals seeking medical or surgical advice. We are presenting a middle-aged man who complained of abdominal pain associated with poor oral intake during the COVID-19 pandemic in January 2021. After being diagnosed with a perforated duodenal ulcer, he underwent laparoscopic repair. He was postoperatively referred to interventional radiology for central line insertion. However, as one of the pre-procedure perquisites during the COVID-19 pandemic, he underwent a nasopharyngeal swab real-time PCR test, which was positive for COVID-19 infection to be considered hospital-acquired. This article shows how the pandemic may complicate the post-surgical condition, increasing patient morbidity and mortality.
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Pazouki A, Mohammadyari F, Maleknia SA, Meymand FE, Gholizadeh B. Laparoscopic repair of an incarcerated Morgagni Hernia in a COVID-19-positive patient: A video case report. Int J Surg Case Rep 2022; 93:106846. [PMID: 35306334 PMCID: PMC8941208 DOI: 10.1016/j.ijscr.2022.106846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/14/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Morgagni Hernia (MH) is a type of congenital diaphragmatic hernia (CDH). CDH is a diaphragmatic discontinuity that permits abdominal viscera to herniate into the chest during development. It does not only occur in early childhood but also has been reported in adults. The most prevalent clinical sign of MH is respiratory disorder of all ages. Case presentation An elderly woman with a known history of diabetes, ischemic heart disease, hypertension, and constipation presented to us with increased abdominal pain. Besides, her PCR test results were positive for COVID-19. She underwent diagnostic laparoscopy surgery. The incision was closed with an intracorporeal suture, and then dual mesh was fixed to diaphragmatic wall. The postoperative progress was satisfactory two weeks after surgery. Based on a negative PCR test, the patient was discharged from the hospital. Discussion The foramina of Morgagni is a defect in the costosternal trigons produced by a lack of anterior pleuroperitoneal membrane muscularization. Although gastrointestinal symptoms and cardiorespiratory discomfort are typically connected with the diagnosis and treatment of MH in youngsters, there are a few middle-aged people who, like our case, develop symptoms suddenly. Albeit a paradigm change in the 21st century deems less invasive laparoscopic surgery to be the treatment of choice, open surgical procedures via a trans-thoracic or trans-abdominal route are still used. Conclusion MH is indeed uncommon in adults, but in patients with an acute onset of intestinal obstruction, the possibility of MH should be in mind. It can be fatal if it is misdiagnosed. The possibility of Morgagni hernia should be in mind even in elderly patients Laparoscopic technique is one of the best approaches to the Morgagni hernia cause all abdominal organs can be evaluated with laparoscopy in a minimally invasive manner. The operation can be performed in a COVID-19 positive patient. COVID-19 may be a spark of underlying disease manifestations.
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Affiliation(s)
- Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran.
| | | | - Seyed Adel Maleknia
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran
| | - Faridadin Ebrahimi Meymand
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran
| | - Barmak Gholizadeh
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasool-e-Akram Hospital, Tehran, Iran; Department of General Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Permana GI, Faris M, Subagio EA, Bajamal AH. The effects of the coronavirus disease 2019 pandemic on neurospine surgery practice in the referral center hospital developing country. Surg Neurol Int 2022; 12:620. [PMID: 34992936 PMCID: PMC8720481 DOI: 10.25259/sni_708_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 11/08/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic represents a once in a century challenge to human health care with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. This study reported the effect of the COVID-19 pandemic on the neurosurgical practice, especially neurospine, in the outpatient visit, emergency department, and the surgical procedure. Methods: This study is the comparative retrospective about neurospine practice in the outpatient visit, emergency department, and the surgical procedure among before and during COVID-19 pandemic. We recorded data from January to December 2019 (before COVID-19 pandemic) and compared with the same period in the 2020 (during a COVID-19 pandemic). Results: A total of the outpatient visits, the average number per month was 28 ± 10.5 visits per month before the pandemic. The average number outpatient visit per month during the pandemic was 19 ± 11.1 visits per month, with the lowest in July 2020. The result of the average monthly neurospine surgical procedure before the pandemic was 5 ± 1.9 operations per month. Compared during the pandemic, there was decreased in the neurospine surgical procedure with the average number was 2 ± 2.7 operations per month. The decreased number significantly happens in the surgical procedure and emergency department patient (P < 0.05), while in the outpatient visit, the decreased statistically not significantly (P > 0.05). Conclusion: The COVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines such as neurospine neurosurgery. The COVID-19 pandemic affects in the neurospine and neurosurgery treatment policy in the referral tertiary hospital.
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Affiliation(s)
- Galih Indra Permana
- Department of Neurosurgery, Airlangga University, - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Airlangga University, - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
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Mehrabian D, Liu IZ, Pakhchanian HH, Tarawneh OH, Raiker R, Boyd CJ. Nationwide analysis of plastic and reconstructive procedural volume in the United States during the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2021; 75:1483-1496. [PMID: 34955397 PMCID: PMC8639288 DOI: 10.1016/j.bjps.2021.11.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022]
Abstract
Introduction This study aims to define the impact of the novel Coronavirus Disease 2019 (COVID-19) pandemic on the volume of common plastic and reconstructive procedures in the United States. Methods TrinetX is a national, federated database that was utilized in surveying plastic and reconstructive procedural volumes among 53 Healthcare organizations (HCO) between March 2018 and May 2021. This timeframe was divided into pre-pandemic (March 2018 to February 2020) and pandemic periods (March 2020 to May 2021). Each period was then sub-divided into four seasons of the year and the mean monthly procedural volume per HCO was compared. A student's t-tests comparing pre-pandemic and pandemic seasonal mean procedural volumes were used for statistical analysis. Results A total of 366,032 patient encounters among 53 HCO were included. The average seasonal volume per HCO of all procedures reduced from 872.11 procedures during pre-pandemic seasons to 827.36 during pandemic seasons. Spring 2020 vol declined for most procedures as 15 of 24 (63%) assessed procedure categories experienced statistically significant decreases. Spring 2021 experienced rebounds with 15 of 24 (63%) assessed procedures showing statistically significant increases. Conclusion During the pandemic period, the average procedural volume per HCO of 14 procedure categories was significantly less than the pre-pandemic average procedural volume. Overall, an inverse relationship was observed between novel COVID-19 cases and plastic and reconstructive surgery procedure volumes in the United States.
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Affiliation(s)
- Daniel Mehrabian
- Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Ivan Z Liu
- Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Haig H Pakhchanian
- George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA
| | - Omar H Tarawneh
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA
| | - Rahul Raiker
- West Virginia University School of Medicine, 1 Medical Center Dr, Morgantown, WV 26506, USA
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 222 East 41st Street, New York, NY 10017-6739, USA.
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Anwarali Khan MH, Kow RY, Ramalingam S, Ho JPY, Jaya Raj J, Ganthel Annamalai K, Low CL. COVID-19 Collateral Damage: Management of Periprosthetic Joint Infection in Malaysia. Cureus 2021; 13:e18820. [PMID: 34804677 PMCID: PMC8591933 DOI: 10.7759/cureus.18820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 01/17/2023] Open
Abstract
Background and objective Periprosthetic joint infection (PJI) is one of the dreaded complications in patients after arthroplasty surgeries, owing to the risk of morbidity and arduous investigations and management associated with it. Nevertheless, as Malaysia is currently battling against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic head-on, the treatment for other non-life-threatening diseases including PJI has taken a backseat. In this study, we present a case series of 11 patients with PJI who were managed surgically at the largest tertiary hospital in Malaysia and we hope to shed some light on the difficulties we have encountered during this trying period. Patients and methods Patients with PJIs who underwent surgical intervention during the ongoing COVID-19 pandemic (March 1, 2020, to June 30, 2021) were reviewed and included in this study. The demographic profile of the patients, presenting complaints, prosthesis topography, biochemical investigative findings, surgical interventions, and short-term outcomes were summarized. Results A total of 11 patients were treated surgically at Hospital Kuala Lumpur for PJI. Among them, five patients are still awaiting their second-stage surgeries despite the completion of their antibiotic regimes, and they are fit for the procedure. Conclusion The COVID-19 pandemic has wreaked havoc on the treatment of patients with PJI. In a setting with scarce resources, surgeons should strongly consider single-stage revision surgeries for the treatment of patients with PJI.
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Affiliation(s)
| | - Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | | | - Jade Pei Yuik Ho
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Jeffrey Jaya Raj
- Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
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Welk B, Richard L. Does COVID-19 infection change the need for future surgical interventions? An exploratory analysis. F1000Res 2021; 10:1167. [PMID: 35136581 PMCID: PMC8787588 DOI: 10.12688/f1000research.74861.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is unknown whether recovery from coronavirus disease 2019 (COVID-19) infection leads to an increased need for common surgical procedures. Our objective was to conduct an exploratory analysis of surgical procedures performed after a documented COVID-19 infection. Methods: We conducted a retrospective cohort study using routinely collected data from the province of Ontario, Canada. We identified individuals with a positive COVID-19 test between February 1 2020 and May 31 2020, and matched them 1:2 with individuals who had a negative COVID-19 test during the same period. We used physician billing codes to identify the ten most frequent surgical procedures in the COVID-19 cohort. An at-risk period 30 days after the first positive COVID-19 swab (or matched index date in the control group) until November 30 2020 was used. Cox proportional hazard models (adjusted for important baseline differences) are reported with hazard ratios (HR) and 95% confidence intervals. Results: After exclusions and matching, we had 19,143 people in the COVID-19 cohort, and 38,286 people in the control cohort. The top ten surgical procedures were hand/wrist fracture fixation, cesarean-section, ureteral stent placement, cholecystectomy, treatment of an upper tract urinary stone, hysterectomy, femur fracture repair, hip replacement, transurethral prostatectomy, and appendectomy. There was a significantly reduced hazard of requiring upper tract renal stone surgery (adjusted hazard ratio [aHR] 0.50, 95% confidence interval [CI] 0.29-0.87) or ureteral stent placement (aHR 0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy (aHR 0.43, 95%CI 0.26-0.71) among those with a prior positive COVID-19 test. Conclusions: After a COVID-19 infection there is not an increased risk of needing several common surgical procedures. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy, however understanding the reasons for this will require further study.
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Affiliation(s)
- Blayne Welk
- Surgery, Western University, London, ON, Canada
- ICES, London, Canada
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