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Obidike P, Chang A, Calisi O, Lee JJ, Ssentongo P, Ssentongo AE, Oh JS. COVID-19 and Mortality in the Global Surgical Population: A Systematic Review and Meta-Analysis. J Surg Res 2024; 297:88-100. [PMID: 38460454 DOI: 10.1016/j.jss.2024.01.021] [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: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION To date, no systematic review or meta-analysis has comprehensively estimated the risk of mortality by surgery type on an international scale. We aim to delineate the risk of mortality in patients with COVID-19 who undergo surgery. METHODS PubMed (MEDLINE), Scopus, OVID, the World Health Organization Global Literature on Coronavirus Disease, and Corona-Central databases were searched from December 2019 through January 2022. Studies providing data on mortality in patients undergoing surgery were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for abstracting data were followed and performed independently by two reviewers. The main outcome was mortality in patients with COVID-19. RESULTS Of a total of 4023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 y; 57% were male. Surgery types included general (14.9%), orthopedic (23.4%), vascular (6.4%), thoracic (10.6%), and urologic (8.5%). Patients undergoing surgery with COVID-19 elicited a nine-fold increased risk of mortality (relative risk [RR] 8.99, 95% confidence interval [CI] 4.96-16.32) over those without COVID-19. In low-income and middle-income countries (RR: 16.04, 95% CI: 4.59-56.12), the mortality risk was twice as high compared to high-income countries (RR: 7.50, 95% CI: 4.30-13.09). CONCLUSIONS Mortality risk in surgical patients with COVID-19 compared to those without is increased almost 10-fold. The risk was highest in low-income and middle-income countries compared to high-income countries, suggesting a disproportionate effect of the pandemic on resource-constrained regions.
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Affiliation(s)
- Prisca Obidike
- Department of General Surgery, University of Virginia, Charlottesville, Virginia; Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Allison Chang
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Olivia Calisi
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jungeun J Lee
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John S Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Alelyani RH, Alghamdi AH, Mahrous SM, Alamri BM, Alhiniah MH, Abduh MS, Aldaqal SM. Impact of COVID-19 Pandemic Lockdown on the Prognosis, Morbidity, and Mortality of Patients Undergoing Elective and Emergency Abdominal Surgery: A Retrospective Cohort Study in a Tertiary Center, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15660. [PMID: 36497733 PMCID: PMC9735974 DOI: 10.3390/ijerph192315660] [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: 09/20/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
The SARS-CoV-2 pandemic's main concerns are limiting the spread of infectious diseases and upgrading the delivery of health services, infrastructure, and therapeutic provision. The goal of this retrospective cohort study was to evaluate the emergency experience and delay of elective abdominal surgical intervention at King Abdul-Aziz University Hospital from October 2019 to October 2020, with a focus on post-operative morbidity and mortality before and during the COVID-19 pandemic. This study compares two groups of patients with emergent and elective abdominal surgical procedures between two different periods; the population was divided into two groups: the control group, which included 403 surgical patients, and the lockdown group, which included 253 surgical patients. During the lockdown, surgical activity was reduced by 37.2% (p = 0.014), and patients were more likely to require reoperations and blood transfusions during or after surgery (p= 0.002, 0.021, and 0.018, respectively). During the lockdown period, the average length of stay increased from 3.43 to 5.83 days (p = 0.002), and the patients who developed complications (53.9%) were more than those in the control period (46.1%) (p = 0.001). Our tertiary teaching hospital observed a significant decline in the overall number of surgeries performed during the COVID-19 pandemic and lockdown period. During the lockdown, abdominal surgery was performed only on four patients; they were positive for COVID-19. Three of them underwent exploratory laparotomy; two of the three developed shock post-operative; one patient had colon cancer (ASA score 3), one had colon disease (ASA score 2), and two had perforated bowels (ASA scores 2 and 4, respectively). Two out of four deaths occurred after surgery. Our results showed the impact of the COVID-19 lockdown on surgical care as both 30-day mortality and total morbidity have risen considerably.
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Affiliation(s)
- Rakan H Alelyani
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ali H Alghamdi
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Saad M Mahrous
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bader M Alamri
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mudhawi H Alhiniah
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Maisa S Abduh
- Immune Responses in Different Diseases Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Saleh M Aldaqal
- Immune Responses in Different Diseases Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Garcia GSB, Ferreira KCDAS, Wanderley LS, Pinheiro JMMM, Korsack IM, Frigotto KG. The impact of the COVID-19 pandemic on unilateral inguinal hernioplasty surgery in Brazil. Rev Col Bras Cir 2022; 49:e20223316. [PMID: 36197346 PMCID: PMC10578807 DOI: 10.1590/0100-6991e-20223316-en] [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: 03/04/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze data from patients hospitalized for unilateral inguinal hernioplasty in Brazil in the year before the COVID-19 pandemic, and during the period of the pandemic. METHODS this is a descriptive study, using data referring to hospitalizations for the surgical procedure of unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020, comparing with data from March 2020 to February 2021. Data were collected from the Hospital Information System (SIH/SUS) and the selected variables were: number of hospitalizations, average hospital stay rate and mortality rate. RESULTS in all, 119,312 hospitalizations were performed for unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020. During the pandemic period, 53,445 hospitalizations were recorded for this procedure. The average hospital stay increased compared to the previous year. The mortality rate recorded in the year before the pandemic was 0.11, while in the period of the pandemic, it was 0.20. CONCLUSION It was observed that during the period of the COVID-19 pandemic in Brazil, the number of hospitalizations for unilateral inguinal hernioplasty was reduced by 55,21%. However, there was a significant increase in the mortality rate of this procedure. These results can be explained by the increase in mortality in patients infected with the SARS-CoV-2 virus, and also by the restriction of performing elective surgeries, prioritizing emergency situations, which are more complicated, and consequently, with higher mortality.
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Fehervari M, Das B, Soleimani-Nouri P, Ahmad M, Fadel MG, Deputy M, Morgan C, Burke JR, Mason JD, Nott D, Spalding D. Can surgical skills be taught using technological advances online? A comparative study of online and face-to-face surgical skills training. Surg Endosc 2022; 36:4631-4637. [PMID: 35254521 PMCID: PMC9085701 DOI: 10.1007/s00464-022-09170-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Online teaching has rapidly emerged as a viable alternative to traditional face-to-face education. How to teach surgical skills in the online environment, however, has not yet been fully established nor evaluated. METHODS An international 1-day online surgical skills course consisting of lectures, pre-recorded virtual workshops, live demonstrations and along with surgical skills teaching in breakout rooms was organised. Based on existing learning theories, new methods were developed to deliver skills teaching online. Simultaneously, traditional in-person surgical skills teaching was also conducted and used as a benchmark. Skills development was assessed by trained demonstrators and self-reported competency scores were compared between the online and face-to-face event. RESULTS 553 delegates from 20 different countries attended the online course. Of these, 64 were trained in breakout rooms with a 1:5 demonstrator-to-delegate ratio whilst the remaining 489 delegates participated in didactic skills development sessions. In a separate face-to-face course, 20 delegates were trained with traditional methods. Demonstrators rated the competency of delegates for suturing, tendon repair and vascular anastomosis. There was no significant difference in the competency ratings of delegates receiving online teaching or face-to-face teaching (p = 0.253, p = 0.084, p = 1.00, respectively). The development of the same skills to "articulation" were not different between formats (p = 0.841, p = 0.792, p = 1.00, respectively). Post course self-rated competency scores improved for all technical skills (p < 0.001). Small group sessions, both online and face-to-face, received higher satisfaction ratings compared to large group sessions in terms of clarity of instructions, answers to questions and demonstrator feedback. Overall feedback on teaching quality, however, was equivalent across both groups. DISCUSSION Online teaching of surgical skills for early training years is an appropriate alternative to face-to-face teaching.
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Affiliation(s)
- Matyas Fehervari
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
- Association of Surgeons in Training, London, UK.
| | - Bibek Das
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Payam Soleimani-Nouri
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Manal Ahmad
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- London North West University Healthcare NHS Trust, London, UK
| | - Michael G Fadel
- Association of Surgeons in Training, London, UK
- Chelsea and Westminster Hospital, London, UK
| | - Mohammed Deputy
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, London, UK
| | | | | | | | - David Nott
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Deputy M, Sahnan K, Worley G, Patel K, Balinskaite V, Bottle A, Aylin P, Burns EM, Hart A, Faiz O. The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study. Aliment Pharmacol Ther 2022; 55:836-846. [PMID: 35132663 PMCID: PMC9111430 DOI: 10.1111/apt.16800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) services have been particularly affected by the Covid-19 pandemic. Delays in referral to secondary care and access to investigations and surgery have been exacerbated. AIMS To investigate the use of and outcomes for emergency IBD care during the Covid-19 pandemic. METHODS Nationwide observational study using administrative data for England (2015-2020) comparing cohorts admitted from 1 January 2015, to 31 January 2020 (pre-pandemic) and from 1 February 2020, to 31 January 2021 (pandemic). Autoregressive integrated moving average forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 to January 2021. RESULTS Large decreases in attendances to hospital for emergency treatment were observed for both acute ulcerative colitis (UC, 16.4%) and acute Crohn's disease (CD, 8.7%). The prevalence of concomitant Covid-19 during the same episode was low [391/16 494 (2.4%) and 349/15 613 (2.2%), respectively]. No significant difference in 30-day mortality was observed. A shorter median length of stay by 1 day for acute IBD admissions was observed (P < 0.0001). A higher rate of emergency readmission within 28 days for acute UC was observed (14.1% vs 13.4%, P = 0.012). All IBD procedures and investigations showed decreases in volume from February 2020 to January 2021 compared with counterfactual estimates. The largest absolute deficit was in endoscopy (17 544 fewer procedures, 35.2% reduction). CONCLUSION There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised.
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Affiliation(s)
- Mohammed Deputy
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Kapil Sahnan
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Guy Worley
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Komal Patel
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | | | - Alex Bottle
- Dr Foster Unit, School of Public HealthImperial College LondonLondonUK
| | - Paul Aylin
- Dr Foster Unit, School of Public HealthImperial College LondonLondonUK
| | - Elaine M Burns
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Ailsa Hart
- Department of GastroenterologySt Mark’s Hospital and Academic InstituteHarrowUK
| | - Omar Faiz
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
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Kempf E, Priou S, Lamé G, Daniel C, Bellamine A, Sommacale D, Belkacemi Y, Bey R, Galula G, Taright N, Tannier X, Rance B, Flicoteaux R, Hemery F, Audureau E, Chatellier G, Tournigand C. Impact of two waves of Sars-Cov2 outbreak on the number, clinical presentation, care trajectories and survival of patients newly referred for a colorectal cancer: A French multicentric cohort study from a large group of university hospitals. Int J Cancer 2022; 150:1609-1618. [PMID: 35001364 PMCID: PMC9015603 DOI: 10.1002/ijc.33928] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
The SARS‐Cov2 may have impaired care trajectories, patient overall survival (OS), tumor stage at initial presentation for new colorectal cancer (CRC) cases. This study aimed at assessing those indicators before and after the beginning of the pandemic in France. In this retrospective cohort study, we collected prospectively the clinical data of the 11.4 million of patients referred to the Greater Paris University Hospitals (AP‐HP). We identified new CRC cases between 1 January 2018 and 31 December 2020, and compared indicators for 2018‐2019 to 2020. pTNM tumor stage was extracted from postoperative pathology reports for localized colon cancer, and metastatic status was extracted from CT‐scan baseline text reports. Between 2018 and 2020, 3602 and 1083 new colon and rectal cancers were referred to the AP‐HP, respectively. The 1‐year OS rates reached 94%, 93% and 76% for new CRC patients undergoing a resection of the primary tumor, in 2018‐2019, in 2020 without any Sars‐Cov2 infection and in 2020 with a Sars‐Cov2 infection, respectively (HR 3.78, 95% CI 2.1‐7.1). For patients undergoing other kind of anticancer treatment, the percentages are 64%, 66% and 27% (HR 2.1, 95% CI 1.4‐3.3). Tumor stage at initial presentation, emergency level of primary tumor resection, delays between the first multidisciplinary meeting and the first anticancer treatment did not differ over time. The SARS‐Cov2 pandemic has been associated with less newly diagnosed CRC patients and worse 1‐year OS rates attributable to the infection itself rather than to its impact on hospital care delivery or tumor stage at initial presentation.
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Affiliation(s)
- Emmanuelle Kempf
- Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Paris, France
| | - Sonia Priou
- IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Guillaume Lamé
- Laboratoire Génie Industriel, Université Paris-Saclay, CentraleSupélec, Gif-sur-Yvette, France
| | - Christel Daniel
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Paris, France.,IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Ali Bellamine
- IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Daniele Sommacale
- Department of Digestive Surgery, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Yazid Belkacemi
- Department of Radiation Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Romain Bey
- IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Gilles Galula
- Department of Chronic Diseases and Cancer, Assistance Publique-Hôpitaux de Paris, Head Office, Paris, France
| | - Namik Taright
- Department of Medical Information, Assistance Publique-Hôpitaux de Paris, Head Office, Paris, France
| | - Xavier Tannier
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Paris, France
| | - Bastien Rance
- Department of Medical Informatics, Centre-Université de Paris (APHP-CUP), Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rémi Flicoteaux
- Department of Medical Information, Assistance Publique-Hôpitaux de Paris, Head Office, Paris, France
| | - François Hemery
- Department of Medical Information, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Etienne Audureau
- Clinical Research Unit, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, INSERM, IMRB, CEpiA Team, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Gilles Chatellier
- Department of Medical Informatics, Centre-Université de Paris (APHP-CUP), Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, INSERM, IMRB, Assistance Publique-Hôpitaux de Paris, Créteil, France
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GARCIA GIOVANASALVIANOBRAGA, FERREIRA KARINECOELHODASILVA, WANDERLEY LIGIASOUZA, PINHEIRO JULIAMARIAMENDONÇAMACHADO, KORSACK ISADORAMACIEL, FRIGOTTO KATIAGLEICIELLY. O impacto da pandemia de COVID-19 na cirurgia de hernioplastia inguinal unilateral no Brasil. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar os dados dos pacientes internados para realização de hernioplastia inguinal unilateral no Brasil no ano anterior à pandemia de COVID-19, e durante o período da pandemia no país. Métodos: trata-se de um estudo descritivo, utilizando dados referentes às internações para realização do procedimento cirúrgico de hernioplastia inguinal unilateral no Brasil no período de março de 2019 a fevereiro de 2020, comparando com os dados de março de 2020 até fevereiro de 2021. Os dados foram coletados do Sistema de Informações Hospitalares (SIH/SUS) e as variáveis selecionadas foram: número de internações, taxa média de permanência hospitalar e taxa de mortalidade. Resultados: ao todo, foram realizadas 119.312 internações para realização de hernioplastia inguinal unilateral no Brasil no período de março de 2019 a fevereiro de 2020. Já durante o período de pandemia no país, foram registradas 53.445 internações para este procedimento. A média de permanência hospitalar aumentou em relação ao ano anterior. A taxa de mortalidade registrada no ano anterior à pandemia foi de 0,11, já no período da pandemia, foi de 0,20. Conclusão: foi observado que durante o período de pico da pandemia de COVID-19 no Brasil, o número de internações para realização de hernioplastia inguinal unilateral foi reduzido em 55,21%. Contudo, houve um aumento significativo da taxa de mortalidade desse procedimento. Esse resultado pode ser explicado pelo aumento da mortalidade em pacientes infectados pelo vírus SARS-CoV-2, e também pela restrição da realização de procedimentos cirúrgicos eletivos nesse período, priorizando quadros emergenciais, os quais são mais complicados, e consequentemente, com maior mortalidade.
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Deputy M, Faiz O. Author response to: Effect of the SARS-CoV-2 pandemic on mortality related to high-risk emergency and major elective surgery. Br J Surg 2021; 109:e58. [PMID: 34904157 PMCID: PMC9383091 DOI: 10.1093/bjs/znab367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Mohammed Deputy
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar Faiz
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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9
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Yang X, Yang L, Xiang B, Wen T. Comment on: Effect of the SARS-CoV-2 pandemic on mortality related to high-risk emergency and major elective surgery. Br J Surg 2021; 109:e57. [PMID: 34738098 DOI: 10.1093/bjs/znab366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaodong Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tianfu Wen
- Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, China
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10
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Vollmer MAC, Radhakrishnan S, Kont MD, Flaxman S, Bhatt S, Costelloe C, Honeyford K, Aylin P, Cooke G, Redhead J, Sanders A, Mangan H, White PJ, Ferguson N, Hauck K, Nayagam S, Perez-Guzman PN. The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study. BMC Health Serv Res 2021; 21:1008. [PMID: 34556119 PMCID: PMC8460185 DOI: 10.1186/s12913-021-07008-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. METHODS This analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015-2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average. RESULTS ED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport) and not correlated with any of the spatial dependencies analysed such as increasing distance from postcode of residence to the hospital. Emergency admissions of patients without COVID-19 after March 12, 2020 fell by 48%; we did not observe a significant change to the crude mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p = 0.19). CONCLUSIONS Our study findings reflect broader trends seen across England and give an indication how emergency healthcare seeking has drastically changed. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.
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Affiliation(s)
- Michaela A C Vollmer
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Sreejith Radhakrishnan
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Mara D Kont
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Seth Flaxman
- Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ceire Costelloe
- Imperial College London Department of Primary Care and Public Health, Global Digital Health Unit, St Dunstan's Rd, Hammersmith, London, W6 8RP, UK
| | - Kate Honeyford
- Imperial College London Department of Primary Care and Public Health, Global Digital Health Unit, St Dunstan's Rd, Hammersmith, London, W6 8RP, UK
| | - Paul Aylin
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Graham Cooke
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Julian Redhead
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Alison Sanders
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Helen Mangan
- West London Mental Health NHS Trust, 1 Armstrong Way, Southall, London, UB2 4SD, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Shevanthi Nayagam
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Pablo N Perez-Guzman
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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