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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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Haribhai S, Bhatia K, Shahmanesh M. Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001413. [PMID: 37014874 PMCID: PMC10072489 DOI: 10.1371/journal.pgph.0001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
Globally, 28.4 million non-emergent ('elective') surgical procedures have been deferred during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on elective breast- or colorectal cancer (CRC) procedure backlogs and attributable mortality, globally. Further, we evaluated the interaction between procedure deferrals and health systems, internationally. Relevant articles from any country, published between December 2019-24 November 2022, were identified through searches of online databases (MEDLINE, EMBASE) and by examining the reference lists of retrieved articles. We organised health system-related findings thematically per the Structures-Processes-Outcomes conceptual model by Donabedian (1966). Of 337 identified articles, we included 50. Eleven (22.0%) were reviews. The majority of included studies originated from high-income countries (n = 38, 76.0%). An ecological, modelling study elucidated that global 12-week procedure cancellation rates ranged from 68.3%-73%; Europe and Central Asia accounted for the majority of cancellations (n = 8,430,348) and sub-Saharan Africa contributed the least (n = 520,459). The percentage reduction in global, institutional elective breast cancer surgery activity ranged from 5.68%-16.5%. For CRC, this ranged from 0%-70.9%. Significant evidence is presented on how insufficient pandemic preparedness necessitated procedure deferrals, internationally. We also outlined ancillary determinants of delayed surgery (e.g., patient-specific factors). The following global health system response themes are presented: Structural changes (i.e., hospital re-organisation), Process-related changes (i.e., adapted healthcare provision) and the utilisation of Outcomes (i.e., SARS-CoV-2 infection incidence among patients or healthcare personnel, postoperative pulmonary complication incidence, hospital readmission, length of hospital stay and tumour staging) as indicators of health system response efficacy. Evidence on procedure backlogs and attributable mortality was limited, partly due to insufficient, real-time surveillance of cancer outcomes, internationally. Elective surgery activity has decreased and cancer services have adapted rapidly, worldwide. Further research is needed to understand the impact of COVID-19 on cancer mortality and the efficacy of health system mitigation measures, globally.
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Affiliation(s)
- Sonia Haribhai
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, Durban, South Africa
| | - Komal Bhatia
- Institute for Global Health, University College London, London, United Kingdom
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, Durban, South Africa
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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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Pediatric Residency Training amid the COVID-19 Pandemic: Exploring the Impact of Supervision and Clinical Practice Guidelines on Clinical and Financial Outcomes. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2495064. [PMID: 36148017 PMCID: PMC9489417 DOI: 10.1155/2022/2495064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Objective This study is aimed at calculating the magnitude of the effect of clinical practice guidelines (CPG) and supervision in inhibiting the negative impact of the COVID-19 pandemic on clinical and financial outcomes of non-COVID-19 inpatient care by pediatric residents in academic medical center (AMC) hospitals during the COVID-19 pandemic. Methods The cohort retrospective study was conducted. This study collected patient data from pediatric residency programs. A research cohort consisted of non-COVID-19 pediatric patients at Dr. Soetomo General Academic Hospital. This study compared the subgroup of patients treated during the pandemic with those treated before the pandemic. The results were analyzed using SPSS 26.0 and Smart-PLS. Results There was a 41.4% decrease in pediatric inpatients during the pandemic with an increased severity level and complexity level, a reduction of 7.46% availability of supervisors, an increase of 0.4% in readmission < 30 days, an increase of 0.31% in-hospital mortality, an increase the total costs of care, and a decrease of insurance claim profit. CPG did not moderate the effect of the COVID-19 pandemic on the clinical outcomes (β = −0.006, P = 0.083) but moderated the financial outcomes (β = −0.022, P = 0.000), by reducing the total cost of care and increasing insurance claim profit. Supervision moderated the effect of the COVID-19 pandemic on the clinical outcomes (β = 0.040, P = 0.000) by increasing aLOS and on the financial outcomes (β = −0.031, P = 0.000) by reducing the total cost of care and increasing insurance claim profit. This study model had a 24.0% variance of explanatory power for clinical outcomes and 49.0% for financial outcomes. This study's structural model effectively predicted clinical outcomes (Q2 = 0.238) and financial outcomes (Q2 = 0.413). Conclusion Direct supervision inhibited the negative impact of the COVID-19 pandemic on both clinical and financial outcomes of non-COVID-19 inpatient care by pediatric residents, while CPG only inhibited the negative impact on financial outcomes. Implication of This Study. In a disaster, the availability of CPG and direct supervision makes AMC hospitals able to inhibit the negative impact of disasters on clinical and financial outcomes.
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Robotic Abdominal Surgery and COVID-19: A Systematic Review of Published Literature and Peer-Reviewed Guidelines during the SARS-CoV-2 Pandemic. J Clin Med 2022; 11:jcm11112957. [PMID: 35683346 PMCID: PMC9181746 DOI: 10.3390/jcm11112957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Significant concern emerged at the beginning of the SARS-CoV-2 pandemic regarding the safety and practicality of robotic-assisted surgery (RAS). We aimed to review reported surgical practice and peer-reviewed published review recommendations and guidelines relating to RAS during the pandemic. Methods: A systematic review was performed in keeping with PRISMA guidelines. This study was registered on Open Science Framework. Databases were searched using the following search terms: ‘robotic surgery’, ‘robotics’, ‘COVID-19’, and ‘SARS-CoV-2’. Firstly, articles describing any outcome from or reference to robotic surgery during the COVID-19/SARS-CoV-2 pandemic were considered for inclusion. Guidelines or review articles that outlined recommendations were included if published in a peer-reviewed journal and incorporating direct reference to RAS practice during the pandemic. The ROBINS-I (Risk of Bias in Non-Randomised Studies of Intervention) tool was used to assess the quality of surgical practice articles and guidelines and recommendation publications were assessed using the AGREE-II reporting tool. Publication trends, median time from submission to acceptance were reported along with clinical outcomes and practice recommendations. Results: Twenty-nine articles were included: 15 reporting RAS practice and 14 comprising peer-reviewed guidelines or review recommendations related to RAS during the pandemic, with multiple specialities (i.e., urology, colorectal, digestive surgery, and general minimally invasive surgery) covered. Included articles were published April 2020—December 2021, and the median interval from first submission to acceptance was 92 days. All surgical practice studies scored ‘low’ or ‘moderate’ risk of bias on the ROBINS-I assessment. All guidelines and recommendations scored ‘moderately well’ on the AGREE-II assessment; however, all underperformed in the domain of public and patient involvement. Overall, there were no increases in perioperative complication rates or mortalities in patients who underwent RAS compared to that expected in non-COVID practice. RAS was deemed safe, with recommendations for mitigation of risk of viral transmission. Conclusions: Continuation of RAS was feasible and safe during the SARS-CoV-2 pandemic where resources permitted. Post-pandemic reflections upon published robotic data and publication patterns allows us to better prepare for future events and to enhance urgent guideline design processes.
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Favaro E, Fernandes DR, Vieira LG, Margatho AS, Mendes KDS, Silveira RCDCP. Postoperative complications in adult patients undergoing surgery with confirmed infection by SARS-CoV-2: An integrative review. Rev Lat Am Enfermagem 2021; 29:e3496. [PMID: 34755777 PMCID: PMC8584806 DOI: 10.1590/1518-8345.5346.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE to analyze the evidence available in the literature about postoperative complications in adult patients undergoing surgical procedures with confirmed infection by SARS-CoV-2. METHOD an integrative literature review conducted in the CINAHL, EMBASE, LILACS, PubMed, Scopus and Web of Science databases, as well as in the gray literature. The references identified were exported to the EndNote manager and, subsequently, to the Rayyan web application for study selection. The stages of sampling, categorization of studies, evaluation of the studies included, interpretation of the results and knowledge synthesis were performed by two reviewers independently and in a masked manner. The data were analyzed descriptively. RESULTS of the 247 articles identified, 15 were selected to comprise this review. The prevalent postoperative complications in patients infected with SARS-CoV-2 were the following: cough, dyspnea and hypoxia, need for invasive mechanical ventilation or not, admission to the intensive care unit and death. CONCLUSION the most reported postoperative complications in the studies evaluated were respiratory-related, followed by cardiovascular complications. The importance of preoperative screening for COVID-19 is highlighted, as well as of the monitoring and tracking of confirmed cases in the postoperative period, as these actions exert an impact on reducing the occurrence of complications related to SARS-CoV-2.
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Affiliation(s)
- Erica Favaro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | - Daiane Rubinato Fernandes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior - (CAPES), Brazil
| | - Leticia Genova Vieira
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento
Científico e Tecnológico/Ministério da Ciência, Tecnologia e Inovações,
Brazil
| | - Amanda Salles Margatho
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | - Karina Dal Sasso Mendes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
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Sánchez-Guillén L, Jimenez-Rodriguez RM. Special surgical approaches during peri-COVID-19 pandemic: Robotic and transanal minimally invasive surgery. World J Gastrointest Surg 2021; 13:529-536. [PMID: 34194611 PMCID: PMC8223704 DOI: 10.4240/wjgs.v13.i6.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
During the peri-coronavirus disease 2019 pandemic, the need of special care has raised, not only for our patients but also for health care workers. These needs are different regarding the procedure and the approach performed. This is a dynamic review in the use of robotics and transanal approaches for colorectal diseases. We searched PubMed and KSREvidence.com for studies related to coronavirus disease and robotic surgery/transanal mesorectal excision/transanal surgery (primary and systematic reviews). From 147 results in PubMed, 11 were selected for full text screening, and 11 were included in this paper. From 3 results in KSREvidence, no relevant systematic reviews were identified. We also checked the references in identified papers for further relevant studies. European Society of Coloproctology guidelines were including as part of the recommendations available. Robotic and transanal MIS can be performed safely during the pandemic, but particular characteristics of these procedure need to be taken into consideration.
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Affiliation(s)
- Luis Sánchez-Guillén
- Department of Cirugía General, Hospital Universitario de Elche, Elche 03201, Spain
| | - Rosa M Jimenez-Rodriguez
- Department of Surgery, Hospital Universitario Virgen del Rocio, Unidad de Coloproctologia, Sevilla 41013, Spain
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Pring ET, Malietzis G, Kendall SWH, Jenkins JT, Athanasiou T. Crisis management for surgical teams and their leaders, lessons from the COVID-19 pandemic; A structured approach to developing resilience or natural organisational responses. Int J Surg 2021; 91:105987. [PMID: 34091086 DOI: 10.1016/j.ijsu.2021.105987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/01/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple industries and organisations are afflicted by and respond to institutional crises daily. As surgeons, we respond to crisis frequently and individually such as with critically unwell patients or in mass casualty scenarios; but rarely, do we encounter institutional or multi-institutional crisis with multiple actors as we have seen with the COVID-19 pan-demic. Businesses, private industry and the financial sector have been in a more precar-ious position regarding crisis and consequently have developed rapid response strate-gies employing foresight to reduce risk to assets and financial liquidity. Moreover, large nationalised governmental organisations such as the military have strategies in place ow-ing to a rapidly evolving geopolitical climate with the expectation of immediate new chal-lenges either in the negotiating room or indeed the field of conflict. Despite both nation-alised and privatised healthcare systems existing, both appeared ill-prepared for the COVID-19 global crisis. METHODS A narrative review of the literature was undertaken exploring the approach to crisis man-agement and models used in organisations exposed to institutional crises outside the field of medicine. RESULTS There are many parallels between the organisational management of private business institutions, large military organisations and surgical organisational management in healthcare. Models from management consultancies and the armed forces were ex-plored discussed and adapted for the surgical leader providing a framework through which the surgical leader can bring about an successful response to an institutional crisis and ensure future resilience. CONCLUSION We believe that healthcare, and surgeons (as leaders) in particular, can learn from these other organisations and industries to engage appropriate generic operational plans and contingencies in preparation for whatever further crises may arise in the future, both near and distant. As such, following a review of the literature, we have explored a number of models we believe are adaptable for the surgical community to ensure we remain a dy-namically responsive and ever prepared profession.
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Affiliation(s)
- Edward T Pring
- Department of Surgery, St Mark!s Hospital, Watford Road, Harrow, HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK; Chartered Management Institute, 77 Kingsway, London, WC2B 6SR, UK.
| | - George Malietzis
- Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK
| | - Simon W H Kendall
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK; Society for Cardiothoracic Surgery in Great Britain and Ireland & Hon President, Society Clinical Perfusion Scientists of Great Britain and Ireland, UK
| | - John T Jenkins
- Department of Surgery, St Mark!s Hospital, Watford Road, Harrow, HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Paddington, London, W2 1NY, UK
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Kuryba A, Boyle JM, Blake HA, Aggarwal A, van der Meulen J, Braun M, Walker K, Fearnhead NS. Surgical Treatment and Outcomes of Colorectal Cancer Patients During the COVID-19 Pandemic: A National Population-based Study in England. ANNALS OF SURGERY OPEN 2021; 2:e071. [PMID: 34240077 PMCID: PMC8223908 DOI: 10.1097/as9.0000000000000071] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022] Open
Abstract
To compare the management and outcomes of colorectal cancer (CRC) patients during the first 2 months of the COVID-19 pandemic with the preceding 6 months. BACKGROUND The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection and whether creating "cold" sites (COVID-free hospitals) is effective. METHODS A national study in England used administrative hospital data for 14,930 CRC patients undergoing surgery between October 1, 2019, and May 31, 2020. Mortality of CRC resection was compared before and after March 23, 2020 ("lockdown" start). RESULTS The number of elective CRC procedures dropped sharply during the pandemic (from average 386 to 214 per week), whereas emergency procedures were hardly affected (from 88 to 84 per week). There was little change in characteristics of surgical patients during the pandemic. Laparoscopic surgery decreased from 62.5% to 35.9% for elective and from 17.7% to 9.7% for emergency resections. Surgical mortality increased slightly (from 0.9% to 1.2%, P = 0.06) after elective and markedly (from 5.6% to 8.9%, P = 0.003) after emergency resections. The observed increase in mortality during the first phase of the pandemic was similar in "cold" and "hot" sites (P > 0.5 elective and emergency procedures). CONCLUSIONS The pandemic resulted in a 50% reduction in elective CRC procedures during the initial surge and a substantial increase in mortality after emergency resection. There was no evidence that surgery in COVID-free "cold" sites led to better outcomes in the first 2 months.
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Affiliation(s)
- Angela Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Jemma M Boyle
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A Blake
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Braun
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kate Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicola S Fearnhead
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Monroy-Iglesias MJ, Tagliabue M, Dickinson H, Roberts G, De Berardinis R, Russell B, Moss C, Irwin S, Olsburgh J, Cocco IMF, Schizas A, McCrindle S, Nath R, Brunet A, Simo R, Tornari C, Srinivasan P, Prachalias A, Davies A, Geh J, Fraser S, Routledge T, Ma R, Doerge E, Challacombe B, Nair R, Hadjipavlou M, Scarpinata R, Sorelli P, Dolly S, Mistretta FA, Musi G, Casiraghi M, Aloisi A, Dell’Acqua A, Scaglione D, Zanoni S, Rampazio Da Silva D, Brambilla D, Bertolotti R, Peruzzotti G, Maggioni A, de Cobelli O, Spaggiari L, Ansarin M, Mastrilli F, Gandini S, Jain U, Hamed H, Haire K, Van Hemelrijck M. Continuity of Cancer Care: The Surgical Experience of Two Large Cancer Hubs in London and Milan. Cancers (Basel) 2021; 13:cancers13071597. [PMID: 33808375 PMCID: PMC8036608 DOI: 10.3390/cancers13071597] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic is having a large effect on the management of cancer patients. This study reports on the approach and outcomes of cancer patients receiving radical surgery with curative intent between March and September 2020 (in comparison to 2019) in the European Institute of Oncology, IRCCS (IEO) in Milan and the South East London Cancer Alliance (SELCA). Both institutions implemented a COVID-19 minimal pathway where patients were required to self-isolate prior to admission and were swabbed for COVID-19 within 72 h of surgery. Positive patients had surgery deferred until a negative swab. At IEO, radical surgeries declined by 6% as compared to the same period in 2019 (n = 1477 vs. 1560, respectively). Readmissions were required for 3% (n = 41), and <1% (n = 9) developed COVID-19, of which only one had severe disease and died. At SELCA, radical surgeries declined by 34% (n = 1553 vs. 2336). Readmissions were required for 11% (n = 36), <1% (n = 7) developed COVID-19, and none died from it. Whilst a decline in number of surgeries was observed in both centres, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.
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Affiliation(s)
- Maria J. Monroy-Iglesias
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
- Correspondence: (M.J.M.-I.); (R.D.B.)
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.T.); (M.A.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Harvey Dickinson
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Graham Roberts
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.T.); (M.A.)
- Correspondence: (M.J.M.-I.); (R.D.B.)
| | - Beth Russell
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
| | - Charlotte Moss
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
| | - Sophie Irwin
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Jonathon Olsburgh
- Department of Nephrology and Transplantation, Guy’s & St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Ivana Maria Francesca Cocco
- Department of Colorectal Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (I.M.F.C.); (A.S.)
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (I.M.F.C.); (A.S.)
| | - Sarah McCrindle
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.M.); (S.D.)
| | - Rahul Nath
- Department of Gynaecological Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Aina Brunet
- Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.B.); (R.S.); (C.T.)
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.B.); (R.S.); (C.T.)
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (A.B.); (R.S.); (C.T.)
| | - Parthi Srinivasan
- Department of Liver Studies, King’s College Hospital, London SE5 9RS, UK; (P.S.); (A.P.)
| | - Andreas Prachalias
- Department of Liver Studies, King’s College Hospital, London SE5 9RS, UK; (P.S.); (A.P.)
| | - Andrew Davies
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Jenny Geh
- Department of Plastic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Stephanie Fraser
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.F.); (T.R.); (R.M.)
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.F.); (T.R.); (R.M.)
| | - RuJun Ma
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.F.); (T.R.); (R.M.)
| | - Ella Doerge
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Ben Challacombe
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Raj Nair
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Marios Hadjipavlou
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (E.D.); (B.C.); (R.N.); (M.H.)
| | - Rosaria Scarpinata
- Department of Colorectal Surgery, King’s College Hospital, London SE5 9RS, UK;
| | - Paolo Sorelli
- Department of Colorectal Surgery, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK;
| | - Saoirse Dolly
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (S.M.); (S.D.)
| | | | - Gennaro Musi
- Division of Urology, European Institute of Oncology IRCCS, 20122 Milan, Italy; (F.A.M.); (G.M.); (O.d.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Alessia Aloisi
- Division of Gynaecological Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (A.A.); (A.D.); (A.M.)
| | - Andrea Dell’Acqua
- Division of Gynaecological Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (A.A.); (A.D.); (A.M.)
| | - Donatella Scaglione
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Stefania Zanoni
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Daniele Rampazio Da Silva
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Daniela Brambilla
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Raffaella Bertolotti
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Giulia Peruzzotti
- Division of Data Management, European Institute of Oncology IRCCS, 20122 Milan, Italy; (D.S.); (S.Z.); (D.R.D.S.); (D.B.); (R.B.); (G.P.)
| | - Angelo Maggioni
- Division of Gynaecological Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (A.A.); (A.D.); (A.M.)
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology IRCCS, 20122 Milan, Italy; (F.A.M.); (G.M.); (O.d.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.T.); (M.A.)
| | - Fabrizio Mastrilli
- Medical Administration, European Institute of Oncology, IRCCS, 20122 Milan, Italy;
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Urvashi Jain
- Department of Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (U.J.); (H.H.)
| | - Hisham Hamed
- Department of Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (U.J.); (H.H.)
| | - Kate Haire
- South East London Cancer Alliance, London SE1 9RT, UK; (H.D.); (G.R.); (S.I.); (A.D.); (K.H.)
| | - Mieke Van Hemelrijck
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King’s College London, London WC2R 2LS, UK; (B.R.); (C.M.); (M.V.H.)
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Legacy of COVID-19 - the opportunity to enhance surgical services for patients with colorectal disease. Colorectal Dis 2020; 22:1219-1228. [PMID: 32857886 DOI: 10.1111/codi.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
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Abd-alrazaq A, Schneider J, Mifsud B, Alam T, Househ M, Hamdi M, Shah Z. A Comprehensive Overview of the COVID-19 Literature: Machine Learning–Based Bibliometric Analysis (Preprint).. [DOI: 10.2196/preprints.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19–related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging.
OBJECTIVE
We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature.
METHODS
We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning–based method to analyze the most relevant COVID-19–related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub.
RESULTS
Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19–related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread.
CONCLUSIONS
We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors.
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