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Pirozzi BM, Siragusa L, Baldini G, Pellicciaro M, Grande M, Efrati C, Finizio R, Formica V, Del Vecchio Blanco G, Sica GS. Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic. J Clin Med 2023; 12:jcm12041425. [PMID: 36835958 PMCID: PMC9962694 DOI: 10.3390/jcm12041425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020-28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018-29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.
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Affiliation(s)
- B. M. Pirozzi
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Correspondence:
| | - L. Siragusa
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - G. Baldini
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Pellicciaro
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Grande
- Department of Emergency, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - C. Efrati
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - R. Finizio
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - V. Formica
- Department of Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - G. S. Sica
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Xu F, Wheaton AG, Liu Y, Greenlund KJ. Major ambulatory surgery among US adults with inflammatory bowel disease, 2017. PLoS One 2022; 17:e0264372. [PMID: 35202440 PMCID: PMC8870533 DOI: 10.1371/journal.pone.0264372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/09/2022] [Indexed: 01/13/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) have higher health services use than those without IBD. We investigated patient and hospital characteristics of major ambulatory surgery encounters for Crohn’s disease (CD) or ulcerative colitis (UC) vs non-IBD patients. Methods We conducted a cross-sectional study using 2017 Nationwide Ambulatory Surgery Sample. Major ambulatory surgery encounters among patients aged ≥18 years with CD (n = 20,635) or UC (n = 9,894) were compared to 9.4 million encounters among non-IBD patients. Weighted percentages of patient characteristics (age, sex, median household income, primary payers, patient location, selected comorbidities, discharge destination, type of surgeries) and hospital-related characteristics (hospital size, ownership, location and teaching status, region) were compared by IBD status (CD, UC, and no IBD). Linear regression was used to estimate mean total charges, controlling for these characteristics. Results Compared with non-IBD patients, IBD patients were more likely to have private insurance, reside in urban areas and higher income zip codes, and undergo surgeries in hospitals that were private not-for-profit, urban teaching, and in the Northeast. Gastrointestinal surgeries were more common among IBD patients. Some comorbidities associated with increased risk of surgical complications were more prevalent among IBD patients. Total charges were 9% lower for CD patients aged <65 years (Median: $16,462 vs $18,106) and 6% higher for UC patients aged ≥65 years (Median: $16,909 vs $15,218) compared to their non-IBD patient counterparts. Conclusions Differences in characteristics of major ambulatory surgery encounters by IBD status may identify opportunities for efficient resource allocation and positive surgical outcomes among IBD patients.
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Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Anne G. Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kurt J. Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Maqueda Gonzalez R, Cerdán Santacruz C, García Septiem J, Blanco Terés L, Lopesino González JM, Fernández Jiménez G, Martín-Pérez E. Proctologic emergency consultation during COVID-19: Comparative cross-sectional cohort study. Cir Esp 2021; 99:660-665. [PMID: 34749925 DOI: 10.1016/j.cireng.2021.10.003] [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: 06/13/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Proctologic issues entail a frequent reason for consultation in the emergency department (ED). We aim to analyze how the SARS-COV-2 pandemic has impacted in the demand for proctological consultations. MATERIAL AND METHOD Descriptive comparative retrospective study of cross-sectional cohorts of patients attending the ED for proctological complaints from March to April in 2020 and 2019. Demographic variables, comorbidities, reasons for consultation and diagnosis, treatment and readmission were included. Four periods were analyzed according to the different stages of the pandemic derived limitations. RESULTS A total of 191 patients were reviewed, 58 in 2020 and 133 in 2019 with an average age of 48 years (SD 20.1) and 112 (58.6%) males. The average number of daily consultations was 2.18 patients in 2019 versus 0.95 in 2020 (p=0.025) meaning a 56% reduction in consultations for proctological reasons. This difference in average consultations was significant in both periods of lockout (p=0.001) and previous de-escalation (p=0.014). The diagnosis distribution was similar between both periods; however, perianal abscesses doubled their rate in 2020, 22.4% versus 11.3% (p=0.045). There was an increasing need for surgery, 31% vs 15% (p=0.011) with no difference in outpatients regimen after emergency surgery (12.5% vs 7.5%, p=0.201). Three patients in 2020 required readmission to the ED (5.2% vs 12.9%, p=0.086). CONCLUSION There was a decrease of a 56% in proctologic emergency consultation, however, the need for surgery was twice more frequent during the study period. Reflection on the use of emergencies for proctological reasons is warranted.
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Affiliation(s)
- Rocío Maqueda Gonzalez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain.
| | - Carlos Cerdán Santacruz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
| | - Javier García Septiem
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
| | - Lara Blanco Terés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Guillermo Fernández Jiménez
- Unidad de Información Clínico-Asistencial, Servicio de Admisión y Documentación Clínica, Hospital Universitario La Princesa, Madrid, Spain
| | - Elena Martín-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
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Amjad W, Haider R, Malik A, Qureshi W. Insights into the management of anorectal disease in the coronavirus 2019 disease era. Therap Adv Gastroenterol 2021; 14:17562848211028117. [PMID: 34290826 PMCID: PMC8274100 DOI: 10.1177/17562848211028117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/08/2021] [Indexed: 02/04/2023] Open
Abstract
Coronavirus 2019 disease (COVID-19) has created major impacts on public health. The virus has plagued a large population requiring hospitalization and resource utilization. Knowledge about the COVID-19 virus continues to grow. It can commonly present with gastrointestinal symptoms; initially, this was considered an atypical presentation, which led to delays in care. The pandemic has posed serious threats to the care of anorectal diseases. Urgent surgeries have been delayed, and the care of cancer patients and cancer screenings disrupted. This had added to patient discomfort and the adverse outcomes on healthcare will continue into the future. The better availability of personal protective equipment to providers and standard checklist protocols in operating rooms can help minimize healthcare-related spread of the virus. Telehealth, outpatient procedures, and biochemical tumor marker tests can help with mitigation of anorectal-disease-related problems. There is limited literature about the clinical management of anorectal diseases during the pandemic. We performed a detailed literature review to guide clinicians around management options for anorectal disease patients. We also highlighted the health challenges seen during the pandemic.
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Affiliation(s)
- Waseem Amjad
- Internal Medicine, Albany Medical Center, Albany, NY, USA
| | - Rabbia Haider
- Internal Medicine, Nishter Medical University, Multan, Punjab, Pakistan
| | - Adnan Malik
- Internal Medicine, Loyola University School of Medicine, Chicago, IL, USA
| | - Waqas Qureshi
- Section of Cardiology in Division of Internal Medicine, University of Massachusetts School of Medicine, Worcester, MA 01655, USA
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The Role of Active Inflammation and Surgical Therapy in Crohn's Disease Recurrence. Gastroenterol Res Pract 2020; 2020:2845407. [PMID: 33456458 PMCID: PMC7785378 DOI: 10.1155/2020/2845407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/30/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023] Open
Abstract
An altered balance between effector and regulatory factors is supposed to sustain the tissue-damaging immune response in inflammatory bowel disease (IBD). Several studies demonstrate that severe active inflammation is a strong predictor for surgical complications and recurrence. Indeed, bowel resection in Crohn's disease (CD) patients has a high surgical recurrence rate. In this review, we examined the IBD inflammatory pathways, the current surgical treatments, and the almost inevitable recurrence. The question that might arise is if the cure of intestinal CD is to be found in the surgical approach. A selective search of two databases (PubMed and the Cochrane Library) has been carried out without considering a specific time horizon as inclusion criteria. The scope of this literature review was investigating on the role of inflammation in the management of CD. The following key words have been used to develop the query string: (i) inflammation; (ii) Crohn's disease; (iii) surgery; and (iv) postsurgical recurrence.
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The Role of Inflammation in Crohn's Disease Recurrence after Surgical Treatment. J Immunol Res 2020; 2020:8846982. [PMID: 33426097 PMCID: PMC7781709 DOI: 10.1155/2020/8846982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Postoperative recurrence after surgery for Crohn's disease (CD) is virtually inevitable, and its mechanism is poorly known. Aim To review the numerous factors involved in CD postoperative recurrence (POR) pathogenesis, focusing on single immune system components as well as the immune system as a whole and highlighting the clinical significance in terms of preventive strategies and future perspectives. Methods A systematic literature search on CD POR, followed by a review of the main findings. Results The immune system plays a pivotal role in CD POR, with many different factors involved. Memory T-lymphocytes retained in mesenteric lymph nodes seem to represent the main driving force. New pathophysiology-based preventive strategies in the medical and surgical fields may help reduce POR rates. In particular, surgical strategies have already been developed and are currently under investigation. Conclusions POR is a complex phenomenon, whose driving mechanisms are gradually being unraveled. New preventive strategies addressing these mechanisms seem promising.
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Maqueda Gonzalez R, Cerdán Santacruz C, García Septiem J, Blanco Terés L, Lopesino González JM, Fernández Jiménez G, Martín-Pérez E. Proctologic emergency consultation during COVID-19: Comparative cross-sectional cohort study. Cir Esp 2020; 99:S0009-739X(20)30317-1. [PMID: 33218670 PMCID: PMC7584434 DOI: 10.1016/j.ciresp.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Proctologic issues entail a frequent reason for consultation in the emergency department (ED). We aim to analyze how the SARS-COV-2 pandemic has impacted in the demand for proctological consultations. MATERIAL AND METHOD Descriptive comparative retrospective study of cross-sectional cohorts of patients attending the ED for proctological complaints from March to April in 2020 and 2019. Demographic variables, comorbidities, reasons for consultation and diagnosis, treatment and readmission were included. Four periods were analyzed according to the different stages of the pandemic derived limitations. RESULTS A total of 191 patients were reviewed, 58 in 2020 and 133 in 2019 with an average age of 48 years (SD 20.1) and 112 (58.6%) males. The average number of daily consultations was 2.18 patients in 2019 versus 0.95 in 2020 (p=0.025) meaning a 56% reduction in consultations for proctological reasons. This difference in average consultations was significant in both periods of lockout (p=0.001) and previous de-escalation (p=0.014). The diagnosis distribution was similar between both periods; however, perianal abscesses doubled their rate in 2020, 22.4% versus 11.3% (p=0.045). There was an increasing need for surgery, 31% vs 15% (p=0.011) with no difference in outpatients regimen after emergency surgery (12.5% vs 7.5%, p=0.201). Three patients in 2020 required readmission to the ED (5.2% vs 12.9%, p=0.086). CONCLUSION There was a decrease of a 56% in proctologic emergency consultation, however, the need for surgery was twice more frequent during the study period. Reflection on the use of emergencies for proctological reasons is warranted.
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Affiliation(s)
- Rocío Maqueda Gonzalez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain.
| | - Carlos Cerdán Santacruz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
| | - Javier García Septiem
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
| | - Lara Blanco Terés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Guillermo Fernández Jiménez
- Unidad de Información Clínico-Asistencial, Servicio de Admisión y Documentación Clínica, Hospital Universitario La Princesa, Madrid, Spain
| | - Elena Martín-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain
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Divizia A, Sensi B, Sica GS. Ambulatory management of perianal Crohn's disease during the COVID-19 pandemic. Colorectal Dis 2020; 22:645-646. [PMID: 32348620 PMCID: PMC7267577 DOI: 10.1111/codi.15104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Affiliation(s)
- A. Divizia
- Minimally Invasive and GI SurgeryPoliclinico Tor VergataRomeItaly
| | - B. Sensi
- Minimally Invasive and GI SurgeryPoliclinico Tor VergataRomeItaly
| | - G. S. Sica
- Minimally Invasive and GI SurgeryPoliclinico Tor VergataRomeItaly
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