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Pujol R, Rivas E, Gracia I, Caballero A, Matute P, Cuñat T, Basora M, Fábregas N, Arguis MJ, Forne DL, Balibrea JM, Besa A, Laguna G, Monsalve C, Lacy AM, Martinez-Pallí G. Preoperative triage to detect SARS-CoV-2 infection in surgical patients: lessons learned for resuming surgery. Surg Today 2022; 53:709-717. [PMID: 36266480 PMCID: PMC9589600 DOI: 10.1007/s00595-022-02610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To define the impact of the COVID-19 outbreak on hospital surgical activity and assess the incidence of perioperative COVID-19 within two protocolized screening pathways for elective and non-elective surgery. METHODS We conducted a prospective cohort study of adults undergoing surgery during the COVID-19 outbreak. The elective pathway included telephone surveys and a quantitative polymerase-chain-reaction test (RT-PCR) only for patients who were asymptomatic and at low risk of infection. Only patients with negative screening underwent surgery. In the non-elective pathway, preoperative screening was performed during the hospital admission. RESULTS Among 835 patients considered for the elective pathway, 725 had negative RT-PCR results and underwent surgery. This reflects an 83% reduction in surgical activity from 2019. Moreover, 596 patients underwent non-elective surgery, representing a 28% reduction. Preoperatively, 39 patients (6.5%) tested positive for SARS-CoV-2 and underwent surgery through the non-elective pathway, vs. none in the elective pathway (p < 0.001). Postoperatively, 1.4% of elective surgery patients and 2.2% of non-elective surgery patients tested positive (p > 0.05). Mortality was higher in non-elective surgery (0.6% vs. 2.9%, p < 0.001) and in patients with COVID-19 (0% vs. 14%, p < 0.001). CONCLUSIONS The low incidence of COVID-19 in elective surgeries during the outbreak demonstrates the importance and effectiveness of preoperative screening, combining surveys and RT-PCR.
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Affiliation(s)
- Roger Pujol
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Eva Rivas
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain.,Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Isabel Gracia
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Angel Caballero
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Purificación Matute
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Tomas Cuñat
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Misericordia Basora
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Neus Fábregas
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Maria José Arguis
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Daniel Luis Forne
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - José Maria Balibrea
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Anais Besa
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Guillermo Laguna
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Concepción Monsalve
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Antonio M Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Graciela Martinez-Pallí
- Department of Anesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain. .,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain. .,Biomedical Networking Research Center On Respiratory Diseases (CIBERES), Barcelona, Spain.
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Ojeda A, Calvo A, Cuñat T, Mellado-Artigas R, Comino-Trinidad O, Aliaga J, Arias M, Ferrando C, Martinez-Pallí G, Dürsteler C. Characteristics and influence on quality of life of new-onset pain in critical COVID-19 survivors. Eur J Pain 2021; 26:680-694. [PMID: 34866276 PMCID: PMC9015597 DOI: 10.1002/ejp.1897] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/07/2023]
Abstract
Background Pain is a clinical feature of COVID‐19, however, data about persistent pain after hospital discharge, especially among ICU survivors is scarce. The aim of this study was to explore the incidence and characteristics of new‐onset pain and its impact on Health‐Related Quality of Life (HRQoL), and to quantify the presence of mood disorders in critically ill COVID‐19 survivors. Methods This is a preliminary report of PAIN‐COVID trial (NCT04394169) presenting a descriptive analysis in critically ill COVID‐19 survivors, following in person interview 1 month after hospital discharge. Pain was assessed using the Brief Pain Inventory, the Douleur Neuropathique 4 questionnaire and the Pain Catastrophizing Scale. HRQoL was evaluated with the EQ 5D/5L, and mood disorders with the Hospital Anxiety and Depression Scale (HADS). Results From 27 May to 19 July 2020, 203 patients were consecutively screened for eligibility, and 65 were included in this analysis. Of these, 50.8% patients reported new‐onset pain; 38.5% clinically significant pain (numerical rating score ≥3 for average pain intensity); 16.9% neuropathic pain; 4.6% pain catastrophizing thoughts, 44.6% pain in ≥2 body sites and 7.7% widespread pain. Patients with new‐onset pain had a worse EQ‐VAS and EQ index value (p < 0.001). Pain intensity was negatively correlated to both the former (Spearman ρ: −0.546, p < 0.001) and the latter (Spearman ρ: −0.387, p = 0.001). HADS anxiety and depression values equal or above eight were obtained in 10.8% and 7.7% of patients, respectively. Conclusion New‐onset pain in critically ill COVID‐19 survivors is frequent, and it is associated with a lower HRQoL. Trial registration No.: NCT04394169. Registered 19 May 2020. https://clinicaltrials.gov/ct2/show/NCT04394169. Significance A substantial proportion of severe COVID‐19 survivors may develop clinically significant persistent pain, post‐intensive care syndrome and chronic ICU‐related pain. Given the number of infections worldwide and the unprecedented size of the population of critical illness survivors, providing information about the incidence of new‐onset pain, its characteristics, and its influence on the patients’ quality of life might help establish and improve pain management strategies.
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Affiliation(s)
- Antonio Ojeda
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Andrea Calvo
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Tomas Cuñat
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ricard Mellado-Artigas
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Oscar Comino-Trinidad
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jorge Aliaga
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marilyn Arias
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Carlos Ferrando
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Graciela Martinez-Pallí
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Dürsteler
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Blasi A, Beltran J, Martin N, Martinez-Pallí G, Lozano JJ, Balust J, Torrents A, Taura P. Transient hyperglycemia during liver transplantation does not affect the early graft function. Ann Hepatol 2016; 14:675-87. [PMID: 26256896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent finding in liver transplantation (LT) that remains poorly studied. We aim to describe its appearance in LT recipients of different types of grafts and its relation to the graft function. MATERIAL & METHODS 436 LT recipients of donors after brain death (DBD), donors after cardiac death (DCD), and familial amyloidotic polyneuropathy (FAP) donors were reviewed. Serum glucose was measured at baseline, during the anhepatic phase, after graft reperfusion, and at the end of surgery. Early graft dysfunction (EAD) was assessed by Olthoff criteria. Caspase-3, IFN-γ, IL1β, and IL6 gene expression were measured in liver biopsy. RESULTS The highest increase in glucose levels after reperfusion was observed in FAP LT recipients and the lowest in DCD LT recipients. Glucose level during the anhepatic phase was the only modifiable predictive variable of hyperglycemia after reperfusion. No relation was found between hyperglycemia after reperfusion and EAD. However, recipients with the highest glucose levels after reperfusion tended to achieve the best glucose control at the end of surgery and those who were unable to control the glucose value after reperfusion showed EAD more frequently. The highest levels of caspase-3 were found in recipients with the lowest glucose values after reperfusion. In conclusion, glucose levels increased after graft reperfusion to a different extent according to the donor type. Contrary to general belief, transient hyperglycemia after reperfusion does not appear to impact negatively on the liver graft function and could even be suggested as a marker of graft quality.
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Affiliation(s)
- Annabel Blasi
- Anesthesia Department. Hospital Clinic. Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona. Spain
| | - Joan Beltran
- Anesthesia Department. Hospital Clinic. Barcelona. Spain
| | - Nuria Martin
- Anesthesia Department. Hospital Clinic. Barcelona. Spain
| | - Graciela Martinez-Pallí
- Anesthesia Department. Hospital Clinic. Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona. Spain
| | | | - Jaume Balust
- Anesthesia Department. Hospital Clinic. Barcelona. Spain
| | - Abigail Torrents
- Bioinformatics Platform, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona. Spain
| | - Pilar Taura
- Anesthesia Department. Hospital Clinic. Barcelona. Spain
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Abstract
Thoracoscopy and mediastinoscopy are common procedures with painful incisions and prominent scars. Transesophageal endoscopic mediastinoscopy could reduce pain, improve cosmesis, and provide better access to the posterior mediastinal compartment, especially in patients with a complex mediastinum because of previous mediastinoscopy or with tracheostoma. We describe a new way to access the mediastinum through a natural orifice that provides excellent visualization of mediastinal structures.
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Affiliation(s)
- Henry Córdova
- Endoscopy Unit, Department of Gastroenterology, ICMDiM, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Catalonia, Spain
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Martinez-Pallí G, Barberà JA, Taurà P, Cirera I, Visa J, Rodriguez-Roisin R. Severe portopulmonary hypertension after liver transplantation in a patient with preexisting hepatopulmonary syndrome. J Hepatol 1999; 31:1075-9. [PMID: 10604582 DOI: 10.1016/s0168-8278(99)80321-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Portopulmonary hypertension and hepatopulmonary syndrome have been considered mutually exclusive pulmonary vascular disorders in liver disease states. METHODS This current report describes a middle-aged patient, a candidate for liver transplantation, diagnosed with hepatopulmonary syndrome on the basis of clinical, echocardiographic and gas exchange criteria. Unusually high pulmonary pressures were observed at liver transplantation, performed 6 months after the initial diagnosis of hepatopulmonary syndrome. Three months later, the patient developed severe pulmonary hypertension and died of right ventricular failure during a second attempted liver transplantation. Postmortem histologic findings in the lung confirmed the presence of plexogenic pulmonary arteriopathy. CONCLUSION This case illustrates the potential occurrence of hepatopulmonary syndrome and portopulmonary hypertension in the same patient, suggesting that the presence of hepatopulmonary syndrome may not preclude the development of portopulmonary hypertension.
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Affiliation(s)
- G Martinez-Pallí
- Servei d'Anestesiología i Reanimació, Hospital Clínic, Universitat de Barcelona, Spain
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