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SenthilKumar G, Verhagen NB, Nimmer K, Yang X, Figueroa Castro CE, Szabo A, Taylor BW, Wainaina N, Gould JC, Kothari AN. Risk of Early Postoperative Cardiovascular and Cerebrovascular Complication in Patients with Preoperative COVID-19 Undergoing Cancer Surgery. J Am Coll Surg 2024; 238:1085-1097. [PMID: 38348959 DOI: 10.1097/xcs.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND As the COVID-19 pandemic shifts to an endemic phase, an increasing proportion of patients with cancer and a preoperative history of COVID-19 will require surgery. This study aimed to assess the influence of preoperative COVID-19 on postoperative risk for major adverse cardiovascular and cerebrovascular events (MACEs) among those undergoing surgical cancer resection. Secondary objectives included determining optimal time-to-surgery guidelines based on COVID-19 severity and discerning the influence of vaccination status on MACE risk. STUDY DESIGN National COVID Cohort Collaborative Data Enclave, a large multi-institutional dataset, was used to identify patients that underwent surgical cancer resection between January 2020 and February 2023. Multivariate regression analysis adjusting for demographics, comorbidities, and risk of surgery was performed to evaluate risk for 30-day postoperative MACE. RESULTS Of 204,371 included patients, 21,313 (10.4%) patients had a history of preoperative COVID-19. History of COVID-19 was associated with an increased risk for postoperative composite MACE as well as 30-day mortality. Among patients with mild disease who did not require hospitalization, MACE risk was elevated for up to 4 weeks after infection. Postoperative MACE risk remained elevated more than 8 weeks after infection in those with moderate disease. Vaccination did not reduce risk for postoperative MACE. CONCLUSIONS Together, these data highlight that assessment of the severity of preoperative COVID-19 infection should be a routine component of both preoperative patient screening as well as surgical risk stratification. In addition, strategies beyond vaccination that increase patients' cardiovascular fitness and prevent COVID-19 infection are needed.
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Affiliation(s)
- Gopika SenthilKumar
- From the Medical Scientist Training Program (SenthilKumar), Medical College of Wisconsin, Milwaukee, WI
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Nathaniel B Verhagen
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Kaitlyn Nimmer
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Xin Yang
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Carlos E Figueroa Castro
- Division of Infectious Diseases, Department of Medicine (Figueroa Castro, Wainaina), Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Department of Biostatistics (Szabo), Medical College of Wisconsin, Milwaukee, WI
| | - Bradley W Taylor
- Clinical and Translational Science Institute of Southeastern Wisconsin (Taylor, Kothari), Medical College of Wisconsin, Milwaukee, WI
| | - Njeri Wainaina
- Division of Infectious Diseases, Department of Medicine (Figueroa Castro, Wainaina), Medical College of Wisconsin, Milwaukee, WI
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery (Gould), Medical College of Wisconsin, Milwaukee, WI
| | - Anai N Kothari
- Division of Surgical Oncology, Department of Surgery (SenthilKumar, Verhagen, Nimmer, Yang, Kothari), Medical College of Wisconsin, Milwaukee, WI
- Clinical and Translational Science Institute of Southeastern Wisconsin (Taylor, Kothari), Medical College of Wisconsin, Milwaukee, WI
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2
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Staubli SM, Raptis DA, Ghani S, Davidson BR, Fusai GK, Imber C, Iype S, Nasralla D, Pissanou T, Rahman S, Sharma D, Tinguely P, Haddad F, Dodd M, Dann C, Walker D, Pollok JM. Management of patients at the hepatopancreatobiliary unit of a London teaching hospital during the COVID-19 pandemic. Sci Rep 2023; 13:13432. [PMID: 37596332 PMCID: PMC10439108 DOI: 10.1038/s41598-023-40264-9] [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: 02/28/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
To mitigate COVID-19-related shortage of treatment capacity, the hepatopancreatobiliary (HPB) unit of the Royal Free Hospital London (RFHL) transferred its practice to independent hospitals in Central London through the North Central London Cancer Alliance. The aim of this study was to critically assess this strategy and evaluate perioperative outcomes. Prospectively collected data were reviewed on all patients who were treated under the RFHL HPB unit in six hospitals between November 2020 and October 2021. A total of 1541 patients were included, as follows: 1246 (81%) at the RFHL, 41 (3%) at the Chase Farm Hospital, 23 (2%) at the Whittington Hospital, 207 (13%) at the Princess Grace Hospital, 12 (1%) at the Wellington Hospital and 12 (1%) at the Lister Hospital, Chelsea. Across all institutions, overall complication rate were 40%, major complication (Clavien-Dindo grade ≥ 3a) rate were 11% and mortality rates were 1.4%, respectively. In COVID-19-positive patients (n = 28), compared with negative patients, complication rate and mortality rates were increased tenfold. Outsourcing HPB patients, including their specialist care, to surrounding institutions was safe and ensured ongoing treatment with comparable outcomes among the institutions during the COVID-19 pandemic. Due to the lack of direct comparison with a non-pandemic cohort, these results can strictly only be applied within a pandemic setting.
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Affiliation(s)
- Sebastian M Staubli
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Dimitri A Raptis
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Shahi Ghani
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Brian R Davidson
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Giuseppe K Fusai
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Charles Imber
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Sateesh Iype
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - David Nasralla
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Theodora Pissanou
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Sakhawat Rahman
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Dinesh Sharma
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Pascale Tinguely
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK
| | - Fares Haddad
- Division of Surgery and Interventional Science, University College London, London, UK
- The Princess Grace Hospital (HCA Healthcare UK), London, UK
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Miranda Dodd
- The Princess Grace Hospital (HCA Healthcare UK), London, UK
| | - Chris Dann
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - David Walker
- Division of Surgery and Interventional Science, University College London, London, UK
- The Princess Grace Hospital (HCA Healthcare UK), London, UK
| | - Joerg-Matthias Pollok
- Department of HPB Surgery and Liver Transplantation, Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, UCL Partners, Pond Street, London, NW3 2QG, UK.
- Division of Surgery and Interventional Science, University College London, London, UK.
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3
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Bakkila BF, Marks VA, Kerekes D, Kunstman JW, Salem RR, Billingsley KG, Ahuja N, Laurans M, Olino K, Khan SA. Impact of COVID-19 on the gastrointestinal surgical oncology patient population. Heliyon 2023; 9:e18459. [PMID: 37534012 PMCID: PMC10391949 DOI: 10.1016/j.heliyon.2023.e18459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
Background The onset of the COVID-19 pandemic led to substantial alterations in healthcare delivery and access. In this study, we aimed to evaluate the impact of COVID-19 on the presentation and surgical care of patients with gastrointestinal (GI) cancers. Methods All patients who underwent GI cancer surgery at a large, tertiary referral center between March 15, 2019 and March 15, 2021 were included. March 15, 2020 was considered the start of the COVID-19 pandemic. Changes in patient, tumor, and treatment characteristics before the pandemic compared to during the pandemic were evaluated. Results Of 522 patients that met study criteria, 252 (48.3%) were treated before the COVID-19 pandemic. During the first COVID-19 wave, weekly volume of GI cancer cases was one-third lower than baseline (p = 0.041); during the second wave, case volume remained at baseline levels (p = 0.519). There were no demographic or tumor characteristic differences between patients receiving GI cancer surgery before versus during COVID-19 (p > 0.05 for all), and no difference in rate of emergency surgery (p > 0.9). Patients were more likely to receive preoperative chemotherapy during the first six months of the pandemic compared to the subsequent six months (35.6% vs. 15.5%, p < 0.001). Telemedicine was rapidly adopted at the start of the pandemic, rising from 0% to 47% of GI surgical oncology visits within two months. Conclusions The COVID-19 pandemic caused an initial disruption to the surgical care of GI cancers, but did not compromise stage at presentation. Preoperative chemotherapy and telemedicine were utilized to mitigate the impact of a high COVID-19 burden on cancer care.
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Affiliation(s)
| | | | - Daniel Kerekes
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - John W. Kunstman
- Department of Surgery, Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Ronald R. Salem
- Department of Surgery, Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin G. Billingsley
- Department of Surgery, Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Nita Ahuja
- Department of Surgery, Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Maxwell Laurans
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Kelly Olino
- Department of Surgery, Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Sajid A. Khan
- Department of Surgery, Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
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4
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Doyle JP, Patel PH, Doran SLF, Jiao LR, Cunningham D, Nicol D, Mavroeidis VK, Allum WH, Chaudry AM, Bhogal RH, Kumar S. The Cancer Hub Approach for Upper Gastrointestinal Surgery During COVID-19 Pandemic: Outcomes from a UK Cancer Centre. Ann Surg Oncol 2023; 30:2266-2275. [PMID: 36609639 PMCID: PMC9579643 DOI: 10.1245/s10434-022-12571-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic caused unprecedented disruption to global healthcare delivery. In England, the majority of elective surgery was postponed or cancelled to increase intensive care capacity. Our unit instituted the 'RM Partners Cancer Hub' at the Royal Marsden Hospital in London, to deliver ongoing cancer surgery in a 'COVID-lite' setting. This article describes the operational set-up and outcomes for upper gastrointestinal (UGI) cancer resections performed during this period. METHODS From April 2020 to April 2021, the Royal Marsden Hospital formed the RM Partners Cancer Hub. This approach was designed to coordinate resources and provide as much oncological treatment as feasible for patients across the RM Partners West London Cancer Alliance. A UGI surgical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols, was adopted. RESULTS A total of 231 patients underwent surgery for confirmed or suspected UGI cancer during the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year disease free survival (DFS) and overall survival (OS) for oesophageal (70.8% and 72.9%), gastric (66.7% and 83.3%) and pancreatic cancer resections (68.0% and 88.0%). One patient who developed perioperative COVID-19 during the RM Partners Cancer Hub operation made a full recovery with no lasting clinical sequelae. CONCLUSION Our experience demonstrates that the RM Partners Cancer Hub approach is a safe strategy for continuing upper gastrointestinal (GI) resectional surgery during future periods of healthcare service disruption.
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Affiliation(s)
- Joseph P Doyle
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | - Pranav H Patel
- Department of Surgery, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | | | - Long R Jiao
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | | | - David Nicol
- Department of Surgery, The Royal Marsden Hospital, London, UK
| | - Vasileios K Mavroeidis
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - William H Allum
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - Asif M Chaudry
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
| | - Ricky H Bhogal
- Department of Surgery, The Royal Marsden Hospital, London, UK
- GI Unit, The Royal Marsden Hospital, London, UK
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK
| | - Sacheen Kumar
- Department of Surgery, The Royal Marsden Hospital, London, UK.
- GI Unit, The Royal Marsden Hospital, London, UK.
- Upper GI Surgical Oncology Research Group, The Institute for Cancer Research, London, UK.
- Digestive Disease & Surgery Institute, Cleveland Clinic London Hospital, London, UK.
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5
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Meta-Resolve of Risk Factors for Nosocomial Infection in Patients Undergoing Thoracic Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2836014. [PMID: 36247850 PMCID: PMC9537004 DOI: 10.1155/2022/2836014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/04/2022] [Accepted: 09/10/2022] [Indexed: 01/26/2023]
Abstract
As we all know, various complications may occur after surgery, and postoperative bleeding and infection are the most common in clinical practice. Postoperative infection mainly manifests as abdominal abscess, peritonitis, and fungal infection. Thoracic surgery is a very common clinical operation. It can directly deal with the relevant lesions, so a better curative effect can usually be obtained. However, patients undergoing thoracic surgery are generally more severely ill, with low immune resistance, long duration, and complicated surgical treatment process. Therefore, the probability of nosocomial infection is high, and there are many risk factors for infection. After the occurrence of HAI, it not only increases the suffering and economic burden of patients and the workload of medical staff but also prolongs the hospitalization time of patients, reduces the turnover rate of hospital beds, causes unnecessary economic losses, and affects the social and economic benefits of hospitals. Based on this, this paper proposes to analyze the risk factors of nosocomial infection in patients undergoing thoracic surgery, so as to provide a reference for the prevention or control of nosocomial infection. This paper analyzes the actual situation of nosocomial infection in a city hospital and then uses meta-analysis to determine the factors of nosocomial infection from the perspective of relevant research literature. Meta-analysis results show that patients older than 60 years have twice the risk of postoperative infection compared with patients younger than 60 years.
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Raveglia F, Orlandi R, Li H, Cerfolio R, Tam JKC, Scarci M. Editorial: Rethink Thoracic Surgery as a Whole After the Pandemic. How to Optimize Resources and Deliver Excellent Patient Care. Front Surg 2022; 9:920626. [PMID: 35706849 PMCID: PMC9191574 DOI: 10.3389/fsurg.2022.920626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Riccardo Orlandi
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Robert Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - John Kit Chung Tam
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
| | - Marco Scarci
- Department of Thoracic Surgery, Hammersmith Hospital, London, UK
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7
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Snyder A, Lanuti M, Muniappan A, Price MC, Som A, Little BP. Assessing Public Interest in Elective Surgery During the COVID-19 Pandemic: A Google Trends Analysis. ANNALS OF SURGERY OPEN 2022; 3:e142. [PMID: 37600105 PMCID: PMC10431528 DOI: 10.1097/as9.0000000000000142] [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: 09/29/2021] [Accepted: 01/29/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To determine trends in internet search volume for elective surgery terms during the first peak of the coronavirus disease 2019 (COVID-19) pandemic using Google Trends data. Background Postponement of much-needed elective and urgent oncologic surgeries takes a toll on patients and the health care system. The COVID-19 pandemic has led to a decline in elective surgery volume, partially due to the cancellation of elective surgeries at the start of the pandemic. Methods We performed a cross-sectional analysis of internet search volume trends for elective surgery terms during the first peak of the COVID-19 pandemic using Google Trends data and compared to a control group of terms representing common urgent and oncologic surgeries. Results Search volume for elective surgery terms ("knee replacement," "spinal fusion," "hip replacement," "laminectomy," "cataract surgery") revealed a decrease of up to 54% compared to the prepandemic period, a significantly greater decrease than search volume for urgent and oncologic surgery terms ("C-section," "cholecystectomy," "CABG," "colectomy," "lobectomy," and "mastectomy"). Conclusions The first phase of the COVID-19 pandemic led to sharp declines in search volume for essential elective surgical procedures, which may have been partially due to the cancellation of elective surgeries, but patient factors such as a temporary decline in interest in elective surgery might have also played a role. Attention to internet search volume may be used during future public health crises to monitor public engagement and interest in important health topics, including preventive health measures such as cancer screening.
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Affiliation(s)
| | - Michael Lanuti
- From the Harvard Medical School, Boston, MA
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Ashok Muniappan
- From the Harvard Medical School, Boston, MA
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Melissa C. Price
- From the Harvard Medical School, Boston, MA
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Avik Som
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, MA
| | - Brent P. Little
- From the Harvard Medical School, Boston, MA
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Dorri S, Sari F, Seyedhasani SN, Atashi A, Hashemi E, Olfatbakhsh A. Practical Recommendations for the Preoperative Screening and Protective Protocols in Cancer Surgeries During COVID-19: A Systematic Review. Front Surg 2021; 8:678700. [PMID: 34901132 PMCID: PMC8653426 DOI: 10.3389/fsurg.2021.678700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: The new coronavirus (COVID-19) has posed many new challenges to the health care and the timing of surgical care. At the beginning of the pandemic many guidelines recommended postponing elective surgical procedures to reallocate resources. As regards, delay in cancer treatment could be effective on cancer progression. The aim of this systematic review was to outline a guideline for preoperative screening before cancer surgeries and protecting health care workers during the pandemic. Materials and Methods: This study was conducted through a search in electronic databases up to August 2020. PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar databases were searched without time limitation. The keywords were a combination of preoperative, cancer surgery, COVID-19, and their synonyms. Results: The most commonly used ways to triage preoperatively were telephone pre-assessment for suspicious symptoms and history of contact or travel, 14-day self-isolation, in- hospital queries at admission, temperature monitoring, and isolation in a single room COVID-free ward or physical distancing. Reverse transcription-polymerase chain reaction (RT-PCR) test 24–72 h before operation was recommended commonly, except in inaccessible centers, but non-contrast chest-CT scan is not routinely advised for elective surgeries to salvage medical resources. Recommended personal protective equipment (PPE) for staffs were wearing N95 mask in addition to gown, gloves, eye protection in aerosol-generating procedures (AGPs), and wearing gloves, hats, and disposable surgical masks, practice distancing, and hand hygiene for all staffs. Meanwhile team separation of hospital staffs caring for COVID-19 patients, segregated areas for COVID-19 clean and contact, restriction of visitors and family members, and personal distancing are mostly recommended. Conclusion: We hope this review would be a guidance for triage, preoperative testing, and summarizing safety principles during COVID-19 pandemic alongside with surgical reintegration.
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Affiliation(s)
- Sara Dorri
- Department of Management and Health Information Technology, School of Management and Medical Information Sciences, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Sari
- Clinical Research Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Seyedeh Nahid Seyedhasani
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Alireza Atashi
- E-Health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmatalsadat Hashemi
- Clinical Research Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Asiie Olfatbakhsh
- Clinical Research Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
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9
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Raveglia F, Orlandi R, Rimessi A, Minervini F, Cioffi U, De Simone M, Guttadauro A, Scarci M. Standardization of Procedures to Contain Cost and Reduce Variability of Care After the Pandemic. Front Surg 2021; 8:695341. [PMID: 34250010 PMCID: PMC8264450 DOI: 10.3389/fsurg.2021.695341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our private and professional routine. In particular, the lockdowns have severely affected the entire healthcare system and hospital activities, forcing it to rethink the protocols in force. We suggest that this scenario, in spite of the new challenges involving so far complex healthcare providers, may lead to the unique opportunity to rethink pathways and management of patients. Indeed, having to resume institutional activity after a long interruption that has completely canceled the previously existing schemes, healthcare providers have the unique opportunity to overcome obsolete and “we have always done in this way” model on the wave of the general desire to resume a normal life. Furthermore, the pandemic has highlighted some flaws in our health system, highlighting those critical issues that most need to be addressed. This article is a review of pre-pandemic literature addressing the use of Lean Six Sigma (LSS) and standardization processes in thoracic surgery to improve efficiency. Our goal is to identify the main issues that could be successfully improved along the entire pathway of a patient from the first referral to diagnosis, hospitalization, and surgical operation up to convalescence. Furthermore, we aim to identify the standardization processes that have been implemented to achieve significant improvements in patient outcomes while reducing costs. The methods and goals that could be used in the near future to modernize our healthcare systems are drawn up from a careful reading and interpretation in light of the pandemic of the most significant review articles in the literature.
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Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Riccardo Orlandi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Arianna Rimessi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Fabrizio Minervini
- Thoracic Surgery, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | | | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
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10
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Chong SMY, Hung RKY, Gwozdz A, Irwin S, Eastbury J, Cross T, Ahmed K, Taylor C, Goldenberg SD, Sanderson J, Olsburgh J. 30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway. Ann R Coll Surg Engl 2021; 103:395-403. [PMID: 33956529 PMCID: PMC10335038 DOI: 10.1308/rcsann.2020.7072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Postoperative pulmonary complications and mortality rates during the COVID-19 pandemic have been higher than expected, leading to mass cancellation of elective operating in the UK. To minimise this, the Guy's and St Thomas' Hospital NHS Foundation Trust elective surgery hub and the executive team at London Bridge Hospital (LBH) created an elective operating framework at LBH, a COVID-19 minimal site, in which patients self-isolated for two weeks and proceeded with surgery only following a negative preoperative SARS-CoV-2 polymerase chain reaction swab. The aim was to determine the rates of rates of postoperative COVID-19 infection. METHODS The collaboration involved three large hospital trusts, covering the geographic area of south-east London. All patients were referred to LBH for elective surgery. Patients were followed up by telephone interview at four weeks postoperatively. RESULTS Three hundred and ninety-eight patients from 13 surgical specialties were included in the analysis. The median age was 60 (IQR 29-71) years. Sixty-three per cent (252/398) were female. In total, 78.4% of patients had an American Society of Anesthesiologists grade of 1-2 and the average BMI was 27.2 (IQR 23.7-31.8) kg/m2. Some 83.6% (336/402) were 'major' operations. The rate of COVID-19-related death in our cohort was 0.25% (1/398). Overall, there was a 1.26% (5/398) 30-day postoperative all-cause mortality rate. Seven patients (1.76%) reported COVID-19 symptoms, but none attended the emergency department or were readmitted to hospital as a result. CONCLUSION The risk of contracting COVID-19 in our elective operating framework was very low. We demonstrate that high-volume major surgery is safe, even at the peak of the pandemic, if patients are screened appropriately preoperatively.
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Affiliation(s)
| | | | | | - S Irwin
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | | | | | | | - C Taylor
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - SD Goldenberg
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - J Sanderson
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
| | - J Olsburgh
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK
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Raheja A, Agarwal N, Mohapatra S, Tandon V, Borkar SA, Chandra PS, Kale SS, Suri A. Preparedness and guidelines for neurosurgery in the COVID-19 era: Indian perspective from a tertiary care referral hospital. Neurosurg Focus 2020; 49:E3. [PMID: 33260133 DOI: 10.3171/2020.9.focus20564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has severely impacted healthcare systems globally. The need of the hour is the development of effective strategies for protecting the lives of healthcare providers (HCPs) and judicious triage for optimal utilization of human and hospital resources. During this pandemic, neurosurgery, like other specialties, must transform, innovate, and adopt new guidelines and safety protocols for reducing the risk of cross-infection of HCPs without compromising patient care. In this article, the authors discuss the current neurosurgical practice guidelines at a high-volume tertiary care referral hospital in India and compare them with international guidelines and global consensus for neurosurgery practice in the COVID-19 era. Additionally, the authors highlight some of the modifications incorporated into their clinical practice, including those for stratification of neurosurgical cases, patient triaging based on COVID-19 testing, optimal manpower management, infrastructure reorganization, evolving modules for resident training, and innovations in operating guidelines. The authors recommend the use of their blueprint for stratification of neurosurgical cases, including their protocol for algorithmic patient triage and management and their template for manpower allocation to COVID-19 duty, as a replicable model for efficient healthcare delivery.
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Affiliation(s)
| | | | - Sarita Mohapatra
- 2Microbiology, All India Institute of Medical Sciences, New Delhi, India
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12
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Abstract
OBJECTIVE The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic. SUMMARY OF BACKGROUND DATA Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a "COVID-minimal pathway" was created. METHODS Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The "COVID-minimal surgical pathway" consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections. RESULTS After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56-79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1-6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection. CONCLUSIONS A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.
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13
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Agarwal N, Raheja A, Suri A. Guidelines for Preoperative Testing for Neurosurgery in Coronavirus Disease 2019 (COVID-19) Era: Indian Viewpoint Amidst Global Practice. World Neurosurg 2020; 146:103-112. [PMID: 33283759 PMCID: PMC7584495 DOI: 10.1016/j.wneu.2020.10.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
Abstract
Preoperative testing and evaluation for coronavirus disease 2019 (COVID-19) have been an enigmatic challenge for the neurosurgical community during the pandemic. Since the beginning of the pandemic, laboratory diagnostic methods have evolved substantially, and with them has been the necessity for readily available, fast, and accurate preoperative testing methods. In this article, we provide an overview of the various laboratory testing methods that are presently available and a comprehensive literature review how various institutes and neurosurgical communities across the globe are employing them to ensure safe and effective delivery of surgical care to patients. Through this review, we highlight the guiding principles for preoperative testing, which may serve as a road map for other medical institutions to follow. In addition, we provide an Indian perspective of preoperative testing and share our experience in this regard.
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Affiliation(s)
- Nitish Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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14
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Akula SM, Abrams SL, Steelman LS, Candido S, Libra M, Lerpiriyapong K, Cocco L, Ramazzotti G, Ratti S, Follo MY, Martelli AM, Blalock WL, Piazzi M, Montalto G, Cervello M, Notarbartolo M, Basecke J, McCubrey JA. Cancer therapy and treatments during COVID-19 era. Adv Biol Regul 2020; 77:100739. [PMID: 32773105 PMCID: PMC7319627 DOI: 10.1016/j.jbior.2020.100739] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 04/12/2023]
Abstract
The COVID-19 pandemic has put a serious strain on health treatments as well at the economies of many nations. Unfortunately, there is not currently available vaccine for SARS-Cov-2/COVID-19. Various types of patients have delayed treatment or even routine check-ups and we are adapting to a virtual world. In many cases, surgeries are delayed unless they are essential. This is also true with regards to cancer treatments and screening. Interestingly, some existing drugs and nutraceuticals have been screened for their effects on COVID-19. Certain FDA approved drugs, vitamin, natural products and trace minerals may be repurposed to treat or improve the prevention of COVID-19 infections and disease progression. This review article will summarize how the treatments of various cancer patients has changed during the COVID-19 era as well as discuss the promise of some existing drugs and other agents to be repurposed to treat this disease.
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Affiliation(s)
- Shaw M Akula
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA
| | - Stephen L Abrams
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA
| | - Linda S Steelman
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA
| | - Saverio Candido
- Department of Biomedical and Biotechnological Sciences-Oncological, Clinical and General Pathology Section, University of Catania, Catania, Italy; Research Center for Prevention, Diagnosis and Treatment of Cancer (PreDiCT), University of Catania, Catania, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences-Oncological, Clinical and General Pathology Section, University of Catania, Catania, Italy; Research Center for Prevention, Diagnosis and Treatment of Cancer (PreDiCT), University of Catania, Catania, Italy
| | - Kvin Lerpiriyapong
- Center of Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine and the Hospital for Special Surgery, New York City, NY, USA
| | - Lucio Cocco
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Giulia Ramazzotti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Stefano Ratti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Matilde Y Follo
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Alberto M Martelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - William L Blalock
- Istituto di Genetica Molecolare-Luigi Luca Cavalli Sforza, UOS Bologna, Consiglio Nazionale Delle Ricerche (IGM-CNR), Bologna, Italy; IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manuela Piazzi
- Istituto di Genetica Molecolare-Luigi Luca Cavalli Sforza, UOS Bologna, Consiglio Nazionale Delle Ricerche (IGM-CNR), Bologna, Italy; IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Montalto
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; Institute for Biomedical Research and Innovation, National Research Council (CNR), Palermo, Italy
| | - Melchiorre Cervello
- Institute for Biomedical Research and Innovation, National Research Council (CNR), Palermo, Italy
| | - Monica Notarbartolo
- Department of Biological, Chemical and Pharmaceutical Science and Technology (STEBICEF), University of Palermo, Palermo, Italy
| | - Jorg Basecke
- Sankt-Josefs Hospital, Krankenhausstrasse 13, 49661, Cloppenburg, Germany
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA.
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