Outcomes after emergency abdominal surgery in COVID-19 patients at a referral center in Brazil

Emergency Abdominal Surgery in Children With COVID-19: An National Surgical Quality Improvement Program-Pediatric Propensity Score Matched Analysis

INTRODUCTION

Evidence suggests that coronavirus disease of 2019 (COVID-19) infection is associated with increased perioperative mortality in adults. We hypothesized that children with COVID-19 had worse outcomes after emergency surgery compared to children without COVID-19.

METHODS

Children <18 y who underwent emergency abdominal surgery were included in the 2021 National Surgical Quality Improvement Program-Pediatric database. Children with COVID-19 diagnosed preoperatively were identified. A propensity score-matched analysis was performed, matching demographic and clinical factors. Postoperative morbidity and mortality were assessed. Due to event rarity, a composite outcome for postoperative morbidity was also assessed. Chi-square and Mann-Whitney U tests identified differences between groups. Logistic regression identified the odds of the composite morbidity outcome.

RESULTS

Overall, 13,619 children (median age 10.8 y, interquartile range: 6.4-14.2) underwent emergency abdominal surgery, of whom 224 (1.6%) had COVID-19. The majority were female (58.2%), White (61.3%), and non-Hispanic (53.4%). On unadjusted analysis, there was an association between COVID-19 status and American Society of Anesthesiologists classification (P < 0.01). A greater proportion of COVID-19-positive children had dirty/infected wounds (30.4% versus 22.2%, P < 0.01). Also, a greater proportion of COVID-19-positive children suffered cardiac arrest requiring cardiopulmonary resuscitation (1.3% versus 0.2%, P < 0.01). Matched cohorts of 224 COVID-19-positive and 224 COVID-19-negative children did not differ by demographic or clinical factors (P > 0.05). Propensity score matching did not reveal significant differences in postoperative morbidity or mortality. Children with COVID-19 did not demonstrate increased odds of morbidity analyzed as a composite outcome (odds ratio: 0.65, 95% confidence interval: 0.29-1.48, P = 0.31).

CONCLUSIONS

Contrary to findings in adults, COVID-19 was not associated with worse clinical outcomes in children undergoing emergency abdominal surgery.

Current use of artificial intelligence in the diagnosis and management of acute appendicitis

INTRODUCTION

Acute appendicitis is a common and time-sensitive surgical emergency, requiring rapid and accurate diagnosis and management to prevent complications. Artificial intelligence (AI) has emerged as a transformative tool in healthcare, offering significant potential to improve the diagnosis and management of acute appendicitis. This review provides an overview of the evolving role of AI in the diagnosis and management of acute appendicitis, highlighting its benefits, challenges, and future perspectives.

EVIDENCE ACQUISITION

We performed a literature search on articles published from 2018 to September 2023. We included only original articles.

EVIDENCE SYNTHESIS

Overall, 121 studies were examined. We included 32 studies: 23 studies addressed the diagnosis, five the differentiation between complicated and uncomplicated appendicitis, and 4 studies the management of acute appendicitis.

CONCLUSIONS

AI is poised to revolutionize the diagnosis and management of acute appendicitis by improving accuracy, speed and consistency. It could potentially reduce healthcare costs. As AI technologies continue to evolve, further research and collaboration are needed to fully realize their potential in the diagnosis and management of acute appendicitis.

Clinical-epidemiological changes in patients with non-traumatic acute abdomen during the COVID-19 pandemic: a retrospective study

OBJECTIVE

we intend to demonstrate the clinical alterations and the postoperative evolution in patients with acute abdomen non-traumatic in conservative or surgical treatment during the pandemic compared to a similar period in the last year.

METHOD

a single-center retrospective study, including patients who received clinical-surgical treatment at Hospital do Trabalhador diagnosed with acute abdomen between March and August 2020 and a similar period in 2019.Variables studied ranged from demographic data to indices of social isolation.

RESULTS

515 patients were included, 291 received treatment in a pre-pandemic period and 224 during. There was not statistical difference in relation to comorbidities (p=0.0685), time to diagnosis and seeking medical help. No statistical differences were observed in terms of days of hospitalization (p = 0.4738) and ICU need (p=0.2320). Regarding in-hospital deaths, there was statistical relevance in the age above 60 years (p=0.002) and there were more deaths during the pandemic period (p=0.032). However, when we analyze the factors associated with the number of days until diagnosis by a physician, there was no statistical difference.

CONCLUSION

the analyzed data showed that the pandemic period and age over 60 years were the variables that increased the odds ratio for the in-hospital death outcome. However, the length of stay, days in intensive care unit and postoperative surgical complications showed no significant difference.

The effects of COVID-19 pandemic on emergency anterior abdominal wall hernia surgery: is it safe to postpone elective hernia surgery in the pandemic?

BACKGROUND

The aim of this study was to investigate the effects of the COVID-19 pandemic on emergency anterior abdominal wall hernia surgeries (EAAWHS) by comparing the pandemic period with the control period a year ago and to share our experiences in the pandemic period.

METHODS

This single-center retrospective cohort study included all patients who underwent EAAWHS during the pandemic (from 11 March 2020 to 25 January 2021) and control period (1 year before the same period, from 11 March 2019 to 25 January 2020). Demographic data, preoperative clinical and pathological parameters, intraoperative findings and postoperative complications secondary to operation and COVID-19 infection, length of intensive care and hospital stay of patients were recorded, and the pandemic and control groups were compared.

RESULTS

Of the 87 patients who underwent anterior abdominal wall hernia surgery during the COVID-19 pandemic, 41 (47.1%) were operated emergently and 46 (52.9%) were operated electively. Of the 485 patients who underwent anterior abdominal wall hernia surgery during the control period, 24 (4.95%) were operated emergently and 461 (95.05%) were operated electively. The decrease in the number of elective operations and the increase in the number of emergency operations were significant during the pandemic (p < 0.001).There was a decrease in the number of emergency inguinal hernia operations and an increase in the number of emergency ventral (incisional, umbilical) hernia operations during the pandemic period compared to the control period (p < 0.05).The mortality rates were similar (8.3 vs. 9.8%, p > 0.05) in both periods.

CONCLUSION

Despite the increase in the number of EAAWHS during the COVID-19 pandemic, there was no significant difference in mortality and morbidity rates. EAAWHS can be performed safely during the pandemic by taken necessary and adequate precautions.

SAGES 2022 guidelines regarding the use of laparoscopy in the era of COVID-19

BACKGROUND

SARS-CoV-2 has changed global healthcare since the pandemic began in 2020. The safety of minimally invasive surgery (MIS) utilizing insufflation from the standpoint of safety to the operating room personnel is currently being explored. The aims of this guideline are to examine the existing evidence to provide guidance regarding MIS for the patient with, or suspecting of having, the SARS-CoV-2 as well as the healthcare team involved.

METHODS

Systematic literature reviews were conducted for 2 key questions (KQ) regarding the safety of MIS in the setting of COVID-19 pandemic. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria. Evidence-based recommendations were formulated using a narrative synthesis of the literature by subject experts. Recommendations for future research were also proposed.

RESULTS

In KQ1, a total of 1361 articles were reviewed, with 2 articles meeting inclusion. In KQ2, a total of 977 articles were reviewed, with 4 articles met inclusions criteria, of which 2 studies reported on the SARS-CoV2 virus specifically. Despite many publications in the field, very little well-controlled and unbiased data exist to inform the recommendations. Of that which is available, it shows that both laparoscopic and open operations in Covid-positive patients had similar rates of OR staff positivity rates; however, patients who underwent laparoscopic procedures had a lower perioperative mortality than open procedures. Also, SARS-CoV-2 particles have been detected in the surgical plume at laparoscopy.

CONCLUSION

With demonstrated equivalence of operating room staff exposure, and noninferiority of laparoscopic access with respect to mortality, either laparoscopic or open approaches to abdominal operations may be used in patients with SARS-CoV-2. Measures should be employed for all laparoscopic or open cases to prevent exposure of operating room staff to the surgical plume, as virus can be present in this plume.

Acute Mesenteric Ischemia in COVID-19 Patients

Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

Provider attitudes and satisfaction with rapid preoperative point-of-care COVID-19 testing using ID NOW™

PURPOSE

Healthcare workers have experienced high levels of anxiety during the COVID-19 pandemic, particularly when caring for patients with unknown infection status. We trialled rapid preoperative point-of-care COVID-19 testing using the Abbott ID NOW™ COVID-19 for clinical validation in an urgent surgical population at a single centre in British Columbia, Canada. Here, we sought to determine the opinions and beliefs of operating room (OR) staff on the usefulness and effectiveness of point-of-care tests on workflow and wellbeing in the OR.

METHODS

This descriptive study used a mixed-methods cross-sectional survey of all OR staff (nurses, anesthesiologists, surgeons, and ancillary staff) at a single centre after using the ID NOW for three months. Outcomes of interest included healthcare worker satisfaction with the ID NOW, effects on OR workflow, and worries about COVID-19 transmission.

RESULTS

The overall response rate was 56% (n = 133), and was highest among anesthesiologists (100%, n = 38). Respondents were satisfied with the performance of the ID NOW for rapid COVID-19 testing in preoperative patients, giving it a mean (standard deviation [SD]) rate of 4.4 [1.4] on a five-point scale. Most (115/128, 90%) recommended continued use of the ID NOW on asymptomatic patients while there are active cases of COVID-19 in the community. Respondents felt that preoperative COVID-19 testing with the ID NOW made the OR safer for staff (mean [SD] rate, 4.2 [0.8]) and patients (mean [SD] rate, 4.0 [0.9]).

CONCLUSION

During the COVID-19 pandemic, it is important to maintain the physical and mental wellbeing of hospital staff. Rapid point-of-care testing increased the sense of workplace safety, improved morale, and reduced worry associated with COVID-19 without excessive disruption of OR workflow.