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Harris E. Older Black Men Have Higher Mortality After Elective Surgery. JAMA 2023; 329:969. [PMID: 36884245 DOI: 10.1001/jama.2023.3197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Moriyama AS, Erbs Pessoa JL, Silva Bessa TR, Pereira NC, Mehta JS, Hofling-Lima AL, Dos Santos Forseto A. The Impact of the COVID-19 Pandemic on Corneal Transplantation in Brazil. Cornea 2022; 41:322-327. [PMID: 34864797 DOI: 10.1097/ico.0000000000002949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of the coronavirus disease 2019 pandemic on corneal transplantation (CT) in Brazil. METHODS Data from patients who underwent CT at the Hospital Oftalmológico de Sorocaba (HOS), Brazil, were analyzed. National and state numbers of keratoplasties, patients added to the CT waiting list, and total patients on the waiting list were also obtained. Baseline prepandemic (from January 1, 2019, to March 31, 2020) data were compared with 2 time frames of the coronavirus disease 2019 pandemic: elective CT suspension period (between April 1, 2020, and September 31, 2020) and after elective CT resumption (between October 1, 2020, and April 30, 2021). RESULTS Despite elective CT resumption after the moratorium, the monthly CT rates did not return to baseline at HOS (-14.7%, P = 0.007), São Paulo state (-19.1%, P = 0.001), or Brazil (-30.1%, P < 0.001). The waiting list increased significantly regionally (P < 0.001) and nationally (P < 0.001). Among optical keratoplasties performed at HOS after resuming elective CTs, the proportion of endothelial keratoplasties declined from 38.2% to 30.0% (P < 0.001), whereas penetrating keratoplasties increased from 33.2% to 39.5% (P < 0.001) when comparing with prepandemic data. CONCLUSIONS Keratoplasty numbers dropped significantly locally, regionally, and nationally. Hence, the CT waiting lists had a progressive increase, with significant long-term implications. An estimated increment on monthly CT rates of approximately 34% in São Paulo state, and 91% in Brazil, is required for the CT waiting list to get back to prepandemic numbers over the next 2 years.
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Affiliation(s)
- Aline Silveira Moriyama
- Hospital Oftalmológico de Sorocaba/Banco de Olhos de Sorocaba (Sorocaba Eye Hospital/ Sorocaba Eye Bank), Sorocaba, Brazil
- Escola Paulista de Medicina, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - João Luís Erbs Pessoa
- Central Estadual de Transplantes (São Paulo State Transplants Center), Secretaria da Saúde Do Estado de São Paulo (São Paulo State Secretary of Health), São Paulo, Brazil
| | - Taciana Ribeiro Silva Bessa
- Coordenação Geral, Sistema Nacional de Transplantes (General Coordination, Brazilian National Transplant System), Ministério da Saúde (Ministry of Health), Brasilia, Brazil
| | - Nicolas Cesário Pereira
- Hospital Oftalmológico de Sorocaba/Banco de Olhos de Sorocaba (Sorocaba Eye Hospital/ Sorocaba Eye Bank), Sorocaba, Brazil
| | - Jodhbir Singh Mehta
- Singapore National Eye Centre, Singapore, Singapore; and
- Singapore Eye Research Institute, Singapore, Singapore
| | - Ana Luisa Hofling-Lima
- Escola Paulista de Medicina, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Adriana Dos Santos Forseto
- Hospital Oftalmológico de Sorocaba/Banco de Olhos de Sorocaba (Sorocaba Eye Hospital/ Sorocaba Eye Bank), Sorocaba, Brazil
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Slomski A. Female Patients Fare Worse With Male Surgeons. JAMA 2022; 327:416. [PMID: 35103779 DOI: 10.1001/jama.2022.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dell'Era G, Colombo C, Forleo GB, Curnis A, Marcantoni L, Racheli M, Sartori P, Notarstefano P, De Salvia A, Guerra F, Ziacchi M, Tondo C, Gandolfi E, De Vecchi F, Mascioli G, Coppolino A, Catuzzo B, Amellone C, Mantica M, D'Ascenzo F, Patti G. Reduction of admissions for urgent and elective pacemaker implant during the COVID-19 outbreak in Northern Italy. J Cardiovasc Med (Hagerstown) 2022; 23:22-27. [PMID: 34545009 DOI: 10.2459/jcm.0000000000001189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS The coronavirus disease-19 (COVID-19) outbreak has been recently associated with lower hospitalization rates for acute coronary syndromes. Aim of the study was to investigate whether a similar behaviour is observed in admissions for urgent pacemaker implant. METHODS This retrospective study included 1315 patients from 18 hospitals in Northern Italy with a high number of COVID-19 cases. Hospitalization rates for urgent pacemaker implant were compared between the following periods: 20 February to 20 April 2020 (case period); from 1 January to 19 February 2020 (intra-year control period); from 20 February to 20 April 2019 (inter-year control period). RESULTS The incidence rate of urgent implants was 5.0/day in the case period, 6.0/day in the intra-year control period and 5.8/day in the inter-year control period. Incidence rate in the case period was significantly lower than both the intra-year [incidence rate ratio (IRR): 0.81, 95% CI 0.67-0.99, P = 0.040] and inter-year control periods (IRR: 0.79, 95% CI 0.66-0.95, P = 0.012); this reduction was highest after the national lockdown (IRR 0.68, 95% CI 0.52-0.91, P = 0.009). The prevalence of residents in rural areas undergoing urgent pacemaker implant was lower in the case period (36%) than in both the intra-year (47%, P = 0.03) and inter-year control periods (51%, P = 0.002). Elective pacemaker implants also decreased in the case period, with the incidence rate here being 3.5/day vs. 6.4/day in the intra-year (-45%) and 6.9/day in the inter-year period (-49%). CONCLUSION Despite severe clinical patterns, the COVID-19 outbreak has negatively affected the population presentation to Emergency Departments for bradyarrhythmias requiring urgent pacemaker implant in Northern Italy. This mainly occurred after the national lockdown and concerned patients living in rural areas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, University of Milan, Milan
| | | | | | - Giosué Mascioli
- Division of Electrophysiology - Humanitas Gavazzeni - Bergamo
| | - Aldo Coppolino
- ASL CN1 SC di Cardiologia, Ospedale SS. Annunziata, Savigliano (Cuneo)
| | | | | | | | | | - Giuseppe Patti
- Ospedale Maggiore della Carità Hospital, Novara
- University of Eastern Piedmont, Novara, Italy
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Silvapulle E, Johnson D, Darvall JN. Risk stratification of individuals undergoing surgery after COVID-19 recovery. Br J Anaesth 2022; 128:e37-e39. [PMID: 34742543 PMCID: PMC8501215 DOI: 10.1016/j.bja.2021.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- Earlene Silvapulle
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Douglas Johnson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jai N Darvall
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
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Mattingly AS, Rose L, Eddington HS, Trickey AW, Cullen MR, Morris AM, Wren SM. Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2138038. [PMID: 34878546 PMCID: PMC8655602 DOI: 10.1001/jamanetworkopen.2021.38038] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has affected every aspect of medical care, including surgical treatment. It is critical to understand the association of government policies and infection burden with surgical access across the United States. OBJECTIVE To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. Surgical procedure volume during the 2020 initial COVID-19-related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Data were analyzed from November 2020 through July 2021. EXPOSURES 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. MAIN OUTCOMES AND MEASURES Incidence rate ratios (IRRs) were estimated from a Poisson regression comparing total procedure counts during the initial shutdown (March 15 to May 2, 2020) and subsequent COVID-19 surge (October 22, 2020-January 31, 2021) with corresponding 2019 dates. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. RESULTS A total of 13 108 567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. This included 6 651 921 procedures in 2019 (3 516 569 procedures among women [52.9%]; 613 192 procedures among children [9.2%]; and 1 987 397 procedures among patients aged ≥65 years [29.9%]) and 5 973 573 procedures in 2020 (3 156 240 procedures among women [52.8%]; 482 637 procedures among children [8.1%]; and 1 806 074 procedures among patients aged ≥65 years [30.2%]). The total number of procedures during the initial shutdown period and its corresponding period in 2019 (ie, epidemiological weeks 12-18) decreased from 905 444 procedures in 2019 to 458 469 procedures in 2020, for an IRR of 0.52 (95% CI, 0.44 to 0.60; P < .001) with a decrease of 48.0%. There was a decrease in surgical procedure volume across all major categories compared with corresponding weeks in 2019. During the initial shutdown, otolaryngology (ENT) procedures (IRR, 0.30; 95% CI, 0.13 to 0.46; P < .001) and cataract procedures (IRR, 0.11; 95% CI, -0.11 to 0.32; P = .03) decreased the most among major categories. Organ transplants and cesarean deliveries did not differ from the 2019 baseline. After the initial shutdown, during the ensuing COVID-19 surge, surgical procedure volumes rebounded to 2019 levels (IRR, 0.97; 95% CI, 0.95 to 1.00; P = .10) except for ENT procedures (IRR, 0.70; 95% CI, 0.65 to 0.75; P < .001). There was a correlation between state volumes of patients with COVID-19 and surgical procedure volume during the initial shutdown (r = -0.00025; 95% CI, -0.0042 to -0.0009; P = .003), but there was no correlation during the COVID-19 surge (r = -0.00034; 95% CI, -0.0075 to 0.00007; P = .11). CONCLUSIONS AND RELEVANCE This study found that the initial shutdown period in March through April 2020, was associated with a decrease in surgical procedure volume to nearly half of baseline rates. After the reopening, the rate of surgical procedures rebounded to 2019 levels, and this trend was maintained throughout the peak burden of patients with COVID-19 in fall and winter; these findings suggest that after initial adaptation, health systems appeared to be able to self-regulate and function at prepandemic capacity.
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Affiliation(s)
| | - Liam Rose
- Health Economics Resource Center, Department of Veterans Affairs, Palo Alto, California
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Hyrum S. Eddington
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Amber W. Trickey
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Mark R. Cullen
- Stanford Center for Population Health Sciences, Stanford, California
| | - Arden M. Morris
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sherry M. Wren
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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McCall M, Peebles M, Sandiford NA. Cancellation of elective orthopaedic procedures is not a benign practice and is often preventable. N Z Med J 2021; 134:70-78. [PMID: 34855735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To quantify the reasons for cancelled elective orthopaedic operations, in particular hip and knee arthroplasty. Secondary aims included defining how long these patients had to wait until their operation, and investigating the impact delayed surgery has on patients in terms of re-presentation to healthcare services. METHODS We reviewed hospital records for all cancelled elective orthopaedic operations over a two-year period at a secondary hospital in New Zealand, investigated the reasons for these cancellations, wait times and comorbidities and compared total hip and knee arthroplasty to other elective orthopaedic operations. RESULTS 76 orthopaedic elective cases were cancelled. 28 (37%) were hip and knee arthroplasties. 71% of these arthroplasties were cancelled due to hospital-related factors (bed availability, operating theatre capacity). Mean wait time for an eventual operation was 56.20 days. Hip joint arthroplasties waited significantly longer (76.10 days, p=0.008). 10% of patients awaiting hip and knee arthroplasties re-presented to healthcare services before their eventual operation. CONCLUSIONS Patients are having their elective hip and knee arthroplasty operations cancelled for hospital-related reasons that could be avoidable. There are significant wait times contributing to decreased quality of life and may be contributing to avoidable re-presentation with its associated demand on healthcare services.
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Affiliation(s)
- Matthew McCall
- House Officer, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Mike Peebles
- Registrar, Obstetrics and Gynaecology, Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Nemandra Amir Sandiford
- Orthopaedic Surgeon, Senior Lecturer, University of Otago, Southland Hospital, Southern District Health Board, Invercargill, New Zealand
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Prasad NK, Englum BR, Turner DJ, Lake R, Siddiqui T, Mayorga-Carlin M, Sorkin JD, Lal BK. A Nation-Wide Review of Elective Surgery and COVID-Surge Capacity. J Surg Res 2021; 267:211-216. [PMID: 34157490 PMCID: PMC8213966 DOI: 10.1016/j.jss.2021.05.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/12/2021] [Accepted: 05/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The COVID-19 pandemic has resulted in over 225,000 excess deaths in the United States. A moratorium on elective surgery was placed early in the pandemic to reduce risk to patients and staff and preserve critical care resources. This report evaluates the impact of the elective surgical moratorium on case volumes and intensive care unit (ICU) bed utilization. METHODS This retrospective review used a national convenience sample to correlate trends in the weekly rates of surgical cases at 170 Veterans Affairs Hospitals around the United States from January 1 to September 30, 2020 to national trends in the COVID-19 pandemic. We reviewed data on weekly number of procedures performed and ICU bed usage, stratified by level of urgency (elective, urgent, emergency), and whether an ICU bed was required within 24 hours of surgery. National data on the proportion of COVID-19 positive test results and mortality rates were obtained from the Center for Disease Control website. RESULTS 198,911 unique surgical procedures performed during the study period. The total number of cases performed from January 1 to March 16 was 86,004 compared with 15,699 from March 17 to May 17. The reduction in volume occurred before an increase in the percentage of COVID-19 positive test results and deaths nationally. There was a 91% reduction from baseline in the number of elective surgeries performed allowing 78% of surgical ICU beds to be available for COVID-19 positive patients. CONCLUSION The moratorium on elective surgical cases was timely and effective in creating bed capacity for critically ill COVID-19 patients. Further analyses will allow targeted resource allocation for future pandemic planning.
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Affiliation(s)
- Nikhil K Prasad
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland
| | - Brian R Englum
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas J Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland
| | - Rachel Lake
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland
| | - Tariq Siddiqui
- Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland
| | - Minerva Mayorga-Carlin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland
| | - John D Sorkin
- Geriatrics Research, Education, And Clinical Centre, Veterans Affairs Medical Centre, Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brajesh K Lal
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Surgery Service, Veterans Affairs Medical Centre, Baltimore, Maryland.
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Felfeli T, Ximenes R, Naimark DMJ, Hooper PL, Campbell RJ, El-Defrawy SR, Sander B. The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study. CMAJ Open 2021; 9:E1063-E1072. [PMID: 34815262 PMCID: PMC8612655 DOI: 10.9778/cmajo.20210145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario. METHODS This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years. RESULTS A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries). INTERPRETATION The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont.
| | - Raphael Ximenes
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - David M J Naimark
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Philip L Hooper
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Robert J Campbell
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Beate Sander
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
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Logie K, Doumouras AG, Springer JE, Eskicioglu C, Hong D. Regional Variation in Laparoscopy Use for Elective Colon Cancer Treatment in Canada: The Importance of Fellowship Training Sites. Dis Colon Rectum 2021; 64:1232-1239. [PMID: 33960327 DOI: 10.1097/dcr.0000000000002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/08/2023]
Abstract
BACKGROUND Over the last decade, use of laparoscopy for the treatment of colon cancer has been variable despite evidence of benefit, possibly reflecting surgeon expertise rather than other factors. OBJECTIVE The purpose of this study was to examine the spatial variation in the use of laparoscopy for colon cancer surgery and to determine what factors may influence use. DESIGN This was a population-based retrospective analysis from April 2008 to March 2015. SETTINGS All Canadian provinces (excluding Quebec) were included. PATIENTS The study included all patients ≥18 years of age undergoing elective colectomy for colon cancer. MAIN OUTCOME MEASURES The primary outcome was laparoscopy use rates. Predictors of use included patient and disease characteristics, year of surgery, rurality, hospital and surgeon volumes, and distance from a colorectal fellowship training center. RESULTS A total of 34,725 patients were identified, and 42% underwent laparoscopic surgery. Significant spatial variations in laparoscopy use were identified, with 95% of high-use clusters located ≤100 km and 98% of low-use clusters located >100 km from a colorectal fellowship center. There were no high-use clusters located around large academic centers without colorectal fellowships. At the individual level, patients living within 25 km and 26 to 100 km of a fellowship center were 2.6 and 1.6 times more likely to undergo laparoscopic surgery compared with those >100 km away (95% CI, 2.47-2.79, p < 0.00; 95% CI, 1.53-1.71, p < 0.001). Surgeon and hospital volumes were associated with increased rates of laparoscopy use (p < 0.001). LIMITATIONS Data were obtained from an administrative database, and despite 85% to 95% published validity, they remain subject to misclassification, response, and measurement bias. CONCLUSIONS Significant spatial variations in the use of laparoscopy for colon cancer surgery exist. After adjusting for patient and system factors, proximity to a colorectal fellowship training center remained a strong predictor of laparoscopy use. There remain regional variations in colon cancer treatment, with discrepancies in the surgical care offered to Canadian patients based solely on location. See Video Abstract at http://links.lww.com/DCR/B595. VARIACIN REGIONAL EN EL USO DE LAPAROSCOPIA PARA EL TRATAMIENTO ELECTIVO DEL CNCER DE COLON EN CANAD LA IMPORTANCIA DE LOS SITIOS DE CAPACITACIN PARA RESIDENTES ANTECEDENTES:Durante la última década, la utilización de la laparoscopia para el tratamiento del cáncer de colon ha sido variable a pesar de la evidencia de beneficio; posiblemente reflejando la experiencia del cirujano, más que otros factores.OBJETIVO:Examinar la variación espacial en el uso de la laparoscopia para la cirugía del cáncer de colon y determinar qué factores pueden influir en la utilización.DISEÑO:Análisis retrospectivo poblacional de abril de 2008 a marzo de 2015.ENTORNO CLÍNICO:Todas las provincias canadienses (excepto Quebec).PACIENTES:Todos los pacientes> 18 años sometidos a colectomía electiva por cáncer de colon.PRINCIPALES MEDIDAS DE RESULTADO:El principal resultado fueron las tasas de utilización de laparoscopia. Los predictores de uso incluyeron las características del paciente y la enfermedad, el año de la cirugía, la ruralidad, los volúmenes de hospitales y cirujanos, y la distancia a un centro de formación de residentes colorectales.RESULTADOS:Se identificaron 34.725 pacientes, 42% fueron sometidos a cirugía laparoscópica. Se identificaron variaciones espaciales significativas en el uso de laparoscopia, con el 95% de los conglomerados de alto uso ubicados a <100 km y el 98% de los conglomerados de bajo uso ubicados a> 100 km, desde un centro de residencia colorectal. No había grupos de alto uso ubicados alrededor de grandes centros académicos sin residentes colorrectales. A nivel individual, los pacientes que vivían dentro de los 25 km y 26-100 km de un centro de residentes tenían 2,6 y 1,6 veces más probabilidades de someterse a una cirugía laparoscópica, respectivamente, en comparación con aquellos a> 100 km de distancia (95% CI 2,47-2,79, p <0,00; IC del 95% 1,53-1,71, p <0,001). Los volúmenes de cirujanos y hospitales se asociaron con mayores tasas de utilización de laparoscopia (p <0,001).LIMITACIONES:Los datos se obtuvieron de una base de datos administrativa y, a pesar de una validez publicada del 85-95%, siguen sujetos a errores de clasificación, respuesta y sesgo de medición.CONCLUSIONES:Existen variaciones espaciales significativas en el uso de la laparoscopia para la cirugía del cáncer de colon. Después de ajustar por factores del paciente y del sistema, la proximidad a un centro de formación de residentes colorectales siguió siendo un fuerte predictor del uso de laparoscopia. Sigue habiendo variaciones regionales en el tratamiento del cáncer de colon, con discrepancias en la atención quirúrgica ofrecida a los pacientes canadienses basadas únicamente en la ubicación. Consulte Video Resumen en http://links.lww.com/DCR/B595.
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Affiliation(s)
- Kathleen Logie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
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12
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Mallenahalli S, Fifolt M, Gundeti M, Lakshmanan Y, Gargollo P, Ost MC, Dangle PP. Survey of COVID-19 impact on pediatric urology services. Can J Urol 2021; 28:10834-10840. [PMID: 34657656] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To better understand how the COVID-19 pandemic has forced rapid operational changes in the global healthcare industry, changes implemented on an individual, institutional basis must be considered. There currently is not adequate literature about the overall impact COVID-19 has had on pediatric urology services worldwide. We believe that they have dramatically decreased during the COVID-19 crisis, but have adapted to accommodate changes. We hypothesize that patient care was widely variant due to inadequate standardized recommendations or crisis planning. MATERIALS AND METHODS A web-based survey was deployed to 377 pediatric urologists globally via email to analyze COVID-19's impact on various types of pediatric urology practices. Key categories included impacts on elective services, telemedicine use, finances, and recovery operations. A total of 114 responses were collected between April 29th - May 22nd, 2020. RESULTS The widespread cancellation of elective surgical procedures caused significant disturbances in the field. There was a uniform, significant increase (75%) in telemedicine use across practices. The pandemic has created many changes in care provision for physicians, institutions, and patients themselves. Furthermore, the sudden economic burden on healthcare facilities could lead to cost-cutting measures, creating further strain within institutions. Though telemedicine has its limitations, it is a very viable option when traditional services are unavailable. CONCLUSIONS Immediate steps should be taken to ensure that the recovery phases of pediatric urology practices are as efficient as possible. Institutions should develop task forces to develop critical workflow processes in the event of health crises, while still maintaining patient-centered care. This will be essential in maximizing appropriate care allocation.
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Affiliation(s)
| | - Matthew Fifolt
- University of Alabama at Birmingham School of Public Health, Alabama, USA
| | - Mohan Gundeti
- The University of Chicago Medicine Comer Children's Hospital and Pritzker School of Medicine Chicago, Illinois, USA
| | | | | | - Michael C Ost
- West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Pankaj P Dangle
- Department of Urology, University of Alabama at Birmingham, Alabama, USA
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13
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Byrne H, Chawla A, Gurung G, Hughes G, Rao M. Variations in colorectal cancer surgery practice across the United Kingdom during the COVID-19 pandemic - 'Every land has its own law'. Surgeon 2021; 19:e183-e192. [PMID: 33309261 PMCID: PMC7724990 DOI: 10.1016/j.surge.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/22/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In March 2020 NHS England issued guidelines recognizing the elective component of cancer surgeries may be 'curtailed', due to staffing and supply shortages during the COVID-19 pandemic. However, it suggested, 'local solutions' should be sought in order to protect the delivery of cancer services. We aimed to compare surgeons' practice for the provision of colorectal (CR) cancer surgery across the United Kingdom (UK), against updated Joint Royal Colleges & ACPGBI guidelines and highlight differences in practice, if any. METHOD An online survey was conducted. It examined surgical practice across the UK against current protocols for CR cancer surgeries, during the COVID-19 pandemic. RESULTS 29 individual responses were received from 23 NHS Trusts across the UK. 23/29 (79%) surgeons ceased or experienced delays in their CR cancer surgeries during the pandemic, with 3/29 (10%) yet to reintroduce these services. 19/26 (73%) surgeons instructed their patients to self-isolate prior to surgery, of which 5/19 (26%) correctly enforced a duration of 14 days. 10/19 (53%) participants adhered to guidelines of performing a CT chest within 24 h of surgery. 10/26 (38%) participants believe their patients are experiencing longer hospital admissions in the COVID-19 setting. CONCLUSION This snap shot survey highlights the dramatic variations in CR cancer surgery practice within the UK and inconsistent adherence to protocols. Guidelines will no doubt change as our knowledge of COVID-19 increases both nationally and internationally. It is essential CR surgeons keep up to date with changes in guidance, so uniformity in practice can be maintained.
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Affiliation(s)
- Hannah Byrne
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Aastha Chawla
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Ganga Gurung
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Gemma Hughes
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Milind Rao
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK.
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14
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Qureshi SS, Ramraj D, Chinnaswamy G, Parambil BC, Prasad M, Amin N, Ramanathan S, Khanna N, Laskar S. Assessment of outcomes of elective cancer surgeries in children during coronavirus disease 2019 pandemic: Retrospective cohort study from a tertiary cancer center in India. Medicine (Baltimore) 2021; 100:e26752. [PMID: 34477115 PMCID: PMC8415926 DOI: 10.1097/md.0000000000026752] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/08/2021] [Indexed: 01/05/2023] Open
Abstract
To describe the outcomes of elective cancer surgeries and adverse consequences on the patients and medical staff due to the surgical interventions in children during the Coronavirus Disease 2019 (COVID-19) pandemic.The study included children younger than 15 years who underwent elective cancer surgeries from March 4, 2020 and December 3, 2020.A total of 121 patients (62% male; median age, 3 years) underwent surgery. The surgical procedures included nephrectomies (n = 18), neuroblastoma (n = 26) and soft tissue tumor resections (n = 24) and complex surgical procedures like extended liver resections (n = 2), intra-atrial thrombectomy under cardiopulmonary bypass (n = 2), pancreatoduodenectomy (n = 1), and free microvascular flaps (n = 7). Clavien-Dindo Grade III complications were 5% (n = 6), and there were no postoperative deaths. Preoperative COVID-19 testing was performed in 82% of children, and only 2% showed severe acute respiratory syndrome coronavirus 2 positivity. Postoperatively, 26 children were tested because of specific symptoms and, 6 tested positive for severe acute respiratory syndrome coronavirus 2. Except for a median delay of 23 days in treatment, none of the patients with COVID-19 required critical hospital management. None of the surgical residents or faculty acquired COVID-19, while 4 each medical and support staff were tested positive in the study period.COVID-19 was not a deterrent for continued cancer care, and surgeries could be safely performed adopting universal preventive measures without any added morbidity from COVID-19. Caregivers and centers dealing with childhood cancers can be encouraged to sustain or seek early healthcare.
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Affiliation(s)
- Sajid S. Qureshi
- Division of Paediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Deepak Ramraj
- Division of Paediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Girish Chinnaswamy
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Badira C. Parambil
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Maya Prasad
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Nayana Amin
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Anaesthesia, Tata Memorial Hospital, and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Subramaniam Ramanathan
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Nehal Khanna
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Siddharth Laskar
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
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15
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Rathnayake D, Clarke M, Jayasinghe V. Patient prioritisation methods to shorten waiting times for elective surgery: A systematic review of how to improve access to surgery. PLoS One 2021; 16:e0256578. [PMID: 34460854 PMCID: PMC8404982 DOI: 10.1371/journal.pone.0256578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Concern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems. METHODS We searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement. RESULTS The electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty. CONCLUSIONS Explicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.
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Affiliation(s)
- Dimuthu Rathnayake
- Centre of Public Health, School of Medicine Dentistry and Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mike Clarke
- Centre of Public Health, School of Medicine Dentistry and Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Viraj Jayasinghe
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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16
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Patel NR, El-Karim GA, Mujoomdar A, Mafeld S, Jaberi A, Kachura JR, Tan KT, Oreopoulos GD. Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective. Can Assoc Radiol J 2021; 72:564-570. [PMID: 32864995 PMCID: PMC7459179 DOI: 10.1177/0846537120951960] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada. METHODS An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics. RESULTS Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%). CONCLUSION The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.
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Affiliation(s)
- Neeral R. Patel
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Ghassan Awad El-Karim
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Amol Mujoomdar
- Division of Interventional Radiology,
London Health
Sciences Centre, London, Ontario,
Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Arash Jaberi
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - John R. Kachura
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Kong Teng Tan
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - George D. Oreopoulos
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
- Division of Vascular Surgery, University Health
Network, Toronto, Ontario, Canada
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17
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Johnson CL, Schwartz H, Greenberg A, Hernandez S, Nnamani Silva ON, Wong LE, Martins DB, Broering JM, Kumar SB, Bongiovanni T, Wick EC, Roman SA. Patient Perceptions on Barriers and Facilitators to Accessing Low-acuity Surgery During COVID-19 Pandemic. J Surg Res 2021; 264:30-36. [PMID: 33744775 PMCID: PMC7867400 DOI: 10.1016/j.jss.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. METHODS We administered a cross-sectional survey to patients who had their general and plastic surgical procedures postponed at the onset of the pandemic, asking about barriers to accessing surgical care. Questions addressed dependent care, transportation, employment and insurance status, as well as perceptions of and concerns about COVID-19. Mixed methods and inductive thematic analyses were conducted. RESULTS One hundred thirty-five patients were interviewed. We identified the following patient concerns: contracting COVID-19 in the hospital (46%), being alone during hospitalization (40%), facing financial stressors (29%), organizing transportation (28%), experiencing changes to health insurance coverage (25%), and arranging care for dependents (18%). Nonwhite participants were 5 and 2.5 times more likely to have concerns about childcare and transportation, respectively. Perceptions of decreased hospital safety and the consequences of possible COVID-19 infection led to delay in rescheduling. Education about safety measures and communication about scheduling partially mitigated concerns about COVID-19. However, uncertainty about timeline for rescheduling and resolution of the pandemic contributed to ongoing concerns. CONCLUSIONS Providing effective surgical care during this unprecedented time requires both awareness of societal shifts impacting surgical patients and system-level change to address new barriers to care. Eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
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Affiliation(s)
- Christopher L Johnson
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Hope Schwartz
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Anya Greenberg
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Sophia Hernandez
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Ogonna N Nnamani Silva
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Laura E Wong
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Deborah B Martins
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Jeanette M Broering
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Sandhya B Kumar
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California; Department of Surgery, Zuckerberg San Francisco General Hospital (ZSFGH), San Francisco, California
| | - Tasce Bongiovanni
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California; Department of Surgery, Zuckerberg San Francisco General Hospital (ZSFGH), San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Sanziana A Roman
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California.
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18
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Lal BK, Prasad NK, Englum BR, Turner DJ, Siddiqui T, Carlin MM, Lake R, Sorkin JD. Periprocedural complications in patients with SARS-CoV-2 infection compared to those without infection: A nationwide propensity-matched analysis. Am J Surg 2021; 222:431-437. [PMID: 33384154 PMCID: PMC7836786 DOI: 10.1016/j.amjsurg.2020.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Reports on emergency surgery performed soon after a COVID-19 infection that are not controlled for premorbid risk-factors show increased 30-day mortality and pulmonary complications. This contributed to a virtual cessation of elective surgery during the pandemic surge. To inform evidence-based guidance on the decisions for surgery during the recovery phase of the pandemic, we compare 30-day outcomes in patients testing positive for COVID-19 before their operation, to contemporary propensity-matched COVID-19 negative patients undergoing the same procedures. METHODS This prospective multicentre study included all patients undergoing surgery at 170 Veterans Health Administration (VA) hospitals across the United States. COVID-19 positive patients were propensity matched to COVID-19 negative patients on demographic and procedural factors. We compared 30-day outcomes between COVID-19 positive and negative patients, and the effect of time from testing positive to the date of procedure (≤10 days, 11-30 days and >30 days) on outcomes. RESULTS Between March 1 and August 15, 2020, 449 COVID-19 positive and 51,238 negative patients met inclusion criteria. Propensity matching yielded 432 COVID-19 positive and 1256 negative patients among whom half underwent elective surgery. Infected patients had longer hospital stays (median seven days), higher rates of pneumonia (20.6%), ventilator requirement (7.6%), acute respiratory distress syndrome (ARDS, 17.1%), septic shock (13.7%), and ischemic stroke (5.8%), while mortality, reoperations and readmissions were not significantly different. Higher odds for ventilation and stroke persisted even when surgery was delayed 11-30 days, and for pneumonia, ARDS, and septic shock >30 days after a positive test. DISCUSSION 30-day pulmonary, septic, and ischaemic complications are increased in COVID-19 positive, compared to propensity score matched negative patients. Odds for several complications persist despite a delay beyond ten days after testing positive. Individualized risk-stratification by pulmonary and atherosclerotic comorbidities should be considered when making decisions for delaying surgery in infected patients.
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Affiliation(s)
- Brajesh K Lal
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA.
| | - Nikhil K Prasad
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Brian R Englum
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Douglas J Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Tariq Siddiqui
- Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Minerva Mayorga Carlin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Rachel Lake
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - John D Sorkin
- Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Rubin DS, Huisingh-Scheetz M, Ferguson MK, Nagele P, Peden CJ, Lauderdale DS. U.S. trends in elective and emergent major abdominal surgical procedures from 2002 to 2014 in older adults. J Am Geriatr Soc 2021; 69:2220-2230. [PMID: 33969889 PMCID: PMC8373714 DOI: 10.1111/jgs.17189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/15/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The U.S. population is aging and projected to undergo an increasing number of general surgical procedures. However, recent trends in the frequency of major abdominal procedures in older adults are currently unknown as improvements in non-operative interventions may obviate the need for major surgery. Thus, we evaluated the trends of major abdominal surgical procedures in older adults in the United States. METHODS We performed a retrospective cohort study using the National Inpatient Sample from 2002 to 2014 with trend analysis using National Cancer Institute's Joinpoint Trend Analysis Software. We identified the average annual percent change (AAPC) in the yearly frequency of major abdominal surgical procedures in older adults (≥50 years of age). RESULTS Our cohort included a total of 3,951,947 survey-weighted discharges that included a major abdominal surgery in adults ≥50 years of age between 2002 and 2014. Of these discharges, 2,529,507 (64.0%) were for elective abdominal surgeries, 2,062,835 (52.0%) were for female patients, and mean (SD) age was 61.4 (15.9) years. The frequency of major abdominal procedures (elective and emergent) decreased for adults aged 65-74 (AAPC: -1.43, -1.75, -1.11, p < 0.0001), 75-84 (AAPC: -2.75, -3.33, -2.16, p < 0.001), and ≥85 (AAPC: -4.07, -4.67, -3.47, p < 0.0001). The AAPC for elective procedures decreased for older adults aged 75-84 (AAPC = -1.65; -2.44, -0.85: p = 0.0001) and >85 (AAPC = -3.53; -4.57, -2.48: p < 0.0001). All age groups showed decreases in emergent procedures in 50-64 (AAPC = -1.76, -2.00, -1.52, p < 0.0001), 65-74 (AAPC = -3.59, -4.03, -3.14, p < 0.0001), 75-84 (AAPC = -3.90, -4.34, -3.46, p < 0.0001), ≥85 (AAPC = -4.58, -4.98, -4.17, p < 0.0001) age groups. CONCLUSIONS AND RELEVANCE In this cohort of older adults, the frequency of emergent and elective major abdominal procedures in adults ≥65 years of age decreased with significant variation among individual procedure types. Future studies are needed to identify the generalizability of our findings to other surgical procedures.
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Affiliation(s)
- Daniel S Rubin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Megan Huisingh-Scheetz
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Peter Nagele
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Carol J Peden
- Department of Anesthesiology, University of Southern California, Los Angeles, California, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane S Lauderdale
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
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20
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Scott DAR, Hadden PW, Wilson GA. Impact of the COVID-19 pandemic lockdown on public sector ophthalmic work by New Zealand's ophthalmologists. N Z Med J 2021; 134:120-127. [PMID: 34239151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM In response to the COVID-19 pandemic, the New Zealand government enforced a nationwide 'alert level 4' lockdown from 26 March to 27 April 2020. We assessed the impact of this lockdown on New Zealand's public ophthalmology service. METHOD An anonymous online survey was sent to all New Zealand-based fellows of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) after lockdown. Respondents provided retrospective assessment of practice patterns and their personal health during the COVID-19 lockdown. This was supported by national-level administrative data, allowing survey findings to be contextualised. RESULTS Fifty-seven respondents (response rate 49%) working in the public health system participated. A large majority of respondents reduced elective clinic and surgical volumes by at least 75% (82% and 98%, respectively). National-level information confirmed clinic reduced to 38.2% of normal and elective operating volumes to 11.5%, with virtual visits increasing 17.9-fold. Elective clinic and elective operating volumes promptly recovered to usual volumes on the second month post lockdown. Most respondents (58%) followed the RANZCO triaging guideline, and 28% triaged emergencies only. At a personal level, respondents reported a significant physical health benefit (p<0.001) associated with the lockdown experience, but no change in mental health or social wellbeing. CONCLUSIONS Publicly employed ophthalmologists experienced dramatic reductions to elective clinic and operating volumes during the COVID-19 lockdown. The prompt recovery of service delivery volumes back to pre-lockdown levels supports the value of a COVID-19 elimination strategy in New Zealand. Virtual visits for selected patients allowed ongoing management without risking virus transmission.
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Affiliation(s)
- Daniel A R Scott
- Ophthalmology Non-Vocational Registrar, Department of Ophthalmology, Gisborne Hospital, Hauora Tairāwhiti, Gisborne
| | - Peter W Hadden
- Ophthalmologist, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medicine and Health Sciences, University of Auckland, Auckland
| | - Graham A Wilson
- Ophthalmologist, Department of Ophthalmology, Gisborne Hospital, Hauora Tairāwhiti, Gisborne; Mātai Lab, Gisborne
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21
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Lambracos S, Yuan L, Kennedy-Smith A. COVID-19 and the impact on urology service provision at Capital & Coast District Health Board. N Z Med J 2021; 134:111-119. [PMID: 34239150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To determine the impact on the Capital & Coast District Health Board (CCDHB) urology service of the implementation of nationwide healthcare restrictions in response to the COVID-19 pandemic. METHODS This is an observational retrospective study over a 21 working day period during the implementation of National Hospital Response Framework Alert (NHRFA) level 2. We obtained patient data during this period and a corresponding control period prior to the pandemic. The data was focussed on the volume of operating theatre cases, outpatient consultations, procedural clinic appointments and the estimated avoided outpatient travel. RESULTS Total urology admissions decreased by 27% during the 21-day NHRFA level 2 period. However, acute surgical procedures increased by 30% whereas elective surgical procedures decreased by 32%. Outpatient consultations overall decreased by 32% during NHRFA level 2 despite virtual phone consultations increasing by 274%. Procedural clinic appointments decreased by 85%. The virtual platform also saved each patient an estimated 22.7km of average travel. CONCLUSION The data demonstrate the effects of restrictions in response to a crisis and set a precedent for future management in such scenarios. The data also show how service efficiency can be optimised while providing an environmentally friendly alternative for routine clinical practice.
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Affiliation(s)
- Simon Lambracos
- General Surgery Department, Poole Hospital NHS Trust, Longfleet Road, Poole BH15 2JB, UK
| | - Lance Yuan
- Urology Department, Capital & Coast DHB, Riddiford Street, Newtown, Wellington 6011
| | - Andrew Kennedy-Smith
- Urology Department, Capital & Coast DHB, Riddiford Street, Newtown, Wellington 6011
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Uimonen M, Kuitunen I, Paloneva J, Launonen AP, Ponkilainen V, Mattila VM. The impact of the COVID-19 pandemic on waiting times for elective surgery patients: A multicenter study. PLoS One 2021; 16:e0253875. [PMID: 34228727 PMCID: PMC8259989 DOI: 10.1371/journal.pone.0253875] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A concern has been that health care reorganizations during the first COVID-19 wave have led to delays in elective surgeries, resulting in increased complications and even mortality. This multicenter study examined the changes in waiting times of elective surgeries during the COVID-19 pandemic in Finland. METHODS Data on elective surgery were gathered from three Finnish public hospitals for years 2017-2020. Surgery incidence and waiting times were examined and the year 2020 was compared to the reference years 2017-2019. The mean annual, monthly, and weekly waiting times were calculated with 95% confidence intervals (CI). The most common diagnosis groups were examined separately. FINDINGS A total of 88 693 surgeries were included during the study period. The mean waiting time in 2020 was 92.6 (CI 91.5-93.8) days, whereas the mean waiting time in the reference years was 85.8 (CI 85.1-86.5) days, resulting in an average 8% increase in waiting times in 2020. Elective procedure incidence decreased rapidly in the onset of the first COVID-19 wave in March 2020 but recovered in May and June, after which the surgery incidence was 22% higher than in the reference years and remained at this level until the end of the year. In May 2020 and thereafter until November, waiting times were longer with monthly increases varying between 7% and 34%. In gastrointestinal and genitourinary diseases and neoplasms, waiting times were longer in 2020. In cardiovascular and musculoskeletal diseases, waiting times were shorter in 2020. CONCLUSION The health care reorganizations due to the pandemic have increased elective surgery waiting times by as much as one-third, even though the elective surgery rate increased by one-fifth after the lockdown.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
- * E-mail:
| | - Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Mikkeli Central Hospital, Mikkeli, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti P. Launonen
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Ville M. Mattila
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Mamidanna R, Askari A, Patel K, Adil MT, Jain V, Jambulingam P, Whitelaw D, Rashid F, Munasinghe A, Al-Taan O. Safety and feasibility of resuming bariatric surgery under the cloud of COVID-19. Ann R Coll Surg Engl 2021; 103:524-529. [PMID: 34192498 PMCID: PMC10751989 DOI: 10.1308/rcsann.2021.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. METHODS A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. RESULTS Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41 years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. CONCLUSION With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.
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Affiliation(s)
- R Mamidanna
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - A Askari
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - K Patel
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - MT Adil
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - V Jain
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | | | - D Whitelaw
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - F Rashid
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | | | - O Al-Taan
- Bedfordshire Hospitals NHS Foundation Trust,
UK
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Binyamin Y, Heesen P, Gruzman I, Zlotnik A, Ioscovich A, Ronen A, Weiniger CF, Frank D, Sheiner E, Orbach-Zinger S. A Retrospective Investigation of Neuraxial Anesthesia Rates for Elective Cesarean Delivery Before and During the SARS-CoV-2 Pandemic. Isr Med Assoc J 2021; 23:408-411. [PMID: 34251121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries. OBJECTIVES To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic. METHODS We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications. RESULTS We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001). CONCLUSIONS We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Phillip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Igor Gruzman
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ariel Ronen
- Department of Anesthesiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Carolyn F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Sheiner
- Obstetrics and Gynecology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sharon Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
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Ratushny V, Moore K, Do D. Evaluation of Public Interest in Mohs Surgery and Other Elective Surgical Procedures During the COVID-19 Pandemic. Dermatol Surg 2021; 47:931-933. [PMID: 33927090 PMCID: PMC8231009 DOI: 10.1097/dss.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery. OBJECTIVE Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand. MATERIALS AND METHODS United States national and state-based Google search data for "Mohs surgery" and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends. RESULTS Search volume for "Mohs surgery" and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between "Mohs surgery" search volume and new COVID-19 deaths on a national and state-based level. CONCLUSION Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.
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Affiliation(s)
- Vladimir Ratushny
- Massachusetts Dermatology Associates, Beverly, Massachusetts
- Mass General Brigham Salem Hospital, Salem, Massachusetts
| | - Kevin Moore
- Harvard Combined Dermatology Residency Training Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Daihung Do
- Mass General Brigham Salem Hospital, Salem, Massachusetts
- Harvard Combined Dermatology Residency Training Program, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Kim LG, Sweeting MJ, Armer M, Jacomelli J, Nasim A, Harrison SC. Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic. PLoS One 2021; 16:e0253327. [PMID: 34129649 PMCID: PMC8205127 DOI: 10.1371/journal.pone.0253327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume. Methods We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population. Findings Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5–5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes. Interpretation Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.
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Affiliation(s)
- Lois G. Kim
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Michael J. Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, United Kingdom
| | - Morag Armer
- Public Health England, Wellington House, London, United Kingdom
| | - Jo Jacomelli
- Public Health England, Wellington House, London, United Kingdom
| | - Akhtar Nasim
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Seamus C. Harrison
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
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Kang Y, Zhang GC, Zhu JQ, Fang XY, Niu J, Zhang Y, Wang XJ. Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery: An observational cohort study. Medicine (Baltimore) 2021; 100:e26056. [PMID: 34087847 PMCID: PMC8183836 DOI: 10.1097/md.0000000000026056] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/30/2021] [Indexed: 01/04/2023] Open
Abstract
Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery.We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission.ICU survivors group had higher Barthel Index (BI) scores than non-survivors group (P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0-20, BI 21-40, BI 41-60, BI 61-80 and BI 81-100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20-1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638-0.771). Kaplan-Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different.Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.
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Affiliation(s)
- Yu Kang
- Department of Geriatric Medicine
| | | | - Ji-Qiao Zhu
- Department of Liver and Gallbladder Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | - Jing Niu
- Department of Geriatric Medicine
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28
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Ranney SE, Tsai MH, Breidenstein MW, Sexton KW, Malhotra AK. Using performance frontiers to differentiate elective and capacity-based surgical services. J Trauma Acute Care Surg 2021; 90:935-941. [PMID: 34016917 DOI: 10.1097/ta.0000000000003137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute care surgery (ACS) model of care delivery has many benefits. However, since the ACS surgeon has limited control over the volume, timing, and complexity of cases, traditional metrics of operating room (OR) efficiency almost always measure ACS service as "inefficient." The current study examines an alternative method-performance fronts-of evaluating changes in efficiency and tests the following hypotheses: (1) in an institution with a robust ACS service, performance front methodology is superior to traditional metrics in evaluating OR throughput/efficiency, and (2) introduction of an ACS service with block time allocation will improve OR throughput/efficiency. METHODS Operating room metrics 1-year pre-ACS implementation and post-ACS implementation were collected. Overall OR efficiency was calculated by mean case volumes for the entire OR and ACS and general surgery (GS) services individually. Detailed analysis of these two specific services was performed by gathering median monthly minutes-in block, out of block, after hours, and opportunity unused. The two services were examined using a traditional measure of efficiency and the "fronts" method. Services were compared with each other and also pre-ACS implementation and post-ACS implementation. RESULTS Overall OR case volumes increased by 5% (999 ± 50 to 1,043 ± 46: p < 0.05) with almost all of the increase coming through ACS (27 ± 4 to 68 ± 16: p < 0.05). By traditional metrics, ACS had significantly worse median efficiency versus GS in both periods: pre (0.67 [0.66-0.71] vs. 0.80 [0.78-0.81]) and post (0.75 [0.53-0.77] vs. 0.83 [0.84-0.85]) (p < 0.05). As compared with the pre, GS efficiency improved significantly in post (p < 0.05), but ACS efficiency remained unchanged (p > 0.05). The alternative fronts chart demonstrated the more accurate picture with improved efficiency observed for GS, ACS, and combined. CONCLUSION In an institution with a busy ACS service, the alternative fronts methodology offers a more accurate evaluation of OR efficiency. The provision of an OR for the ACS service improves overall throughput/efficiency.
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Affiliation(s)
- Stephen E Ranney
- From the Department of Surgery (S.E.R., A.K.M.) and Department of Anesthesia (M.H.T., M.W.B.), Larner College of Medicine, Burlington, Vermont; and University of Arkansas for Medical Sciences (K.W.S.), Little Rock, Arkansas
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29
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Thirukumaran CP, Kim Y, Cai X, Ricciardi BF, Li Y, Fiscella KA, Mesfin A, Glance LG. Association of the Comprehensive Care for Joint Replacement Model With Disparities in the Use of Total Hip and Total Knee Replacement. JAMA Netw Open 2021; 4:e2111858. [PMID: 34047790 PMCID: PMC8164097 DOI: 10.1001/jamanetworkopen.2021.11858] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE The Comprehensive Care for Joint Replacement (CJR) model is Medicare's mandatory bundled payment reform to improve quality and spending for beneficiaries who need total hip replacement (THR) or total knee replacement (TKR), yet it does not account for sociodemographic risk factors such as race/ethnicity and income. Results of this study could be the basis for a Medicare payment reform that addresses inequities in joint replacement care. OBJECTIVE To examine the association of the CJR model with racial/ethnic and socioeconomic disparities in the use of elective THR and TKR among older Medicare beneficiaries after accounting for the population of patients who were at risk or eligible for these surgical procedures. DESIGN, SETTING, AND PARTICIPANTS This cohort study used the 2013 to 2017 national Medicare data and multivariable logistic regressions with triple-differences estimation. Medicare beneficiaries who were aged 65 to 99 years, entitled to Medicare, alive at the end of the calendar year, and residing either in the 67 metropolitan statistical areas (MSAs) mandated to participate in the CJR model or in the 104 control MSAs were identified. A subset of Medicare beneficiaries with a diagnosis of arthritis underwent THR or TKR. Data were analyzed from March to December 2020. EXPOSURES Implementation of the CJR model in 2016. MAIN OUTCOMES AND MEASURES Outcomes were separate binary indicators for whether a beneficiary underwent THR or TKR. Key independent variables were MSA treatment status, pre- or post-CJR model implementation phase, combination of race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic beneficiaries) and dual eligibility, and their interactions. Logistic regression models were used to control for patient characteristics, MSA fixed effects, and time trends. RESULTS The 2013 cohort included 4 447 205 Medicare beneficiaries, of which 2 025 357 (45.5%) resided in MSAs with the CJR model. The cohort's mean (SD) age was 77.18 (7.95) years, and it was composed of 2 951 140 female (66.4%), 3 928 432 non-Hispanic White (88.3%), and 657 073 dually eligible (14.8%) beneficiaries. Before the CJR model implementation, rates were highest among non-Hispanic White non-dual-eligible beneficiaries at 1.25% (95% CI, 1.24%-1.26%) for THR use and 2.28% (95% CI, 2.26%-2.29%) for TKR use in MSAs with CJR model. Compared with MSAs without the CJR model and the analogous race/ethnicity and dual-eligibility group, the CJR model was associated with a 0.10 (95% CI, 0.05-0.15; P < .001) percentage-point increase in TKR use for non-Hispanic White non-dual-eligible beneficiaries, a 0.11 (95% CI, 0.004-0.21; P = .04) percentage-point increase for non-Hispanic White dual-eligible beneficiaries, a 0.15 (95% CI, -0.29 to -0.01; P = .04) percentage-point decrease for non-Hispanic Black non-dual-eligible beneficiaries, and a 0.18 (95% CI, -0.34 to -0.01; P = .03) percentage-point decrease for non-Hispanic Black dual-eligible beneficiaries. These CJR model-associated changes in TKR use were 0.25 (95% CI, -0.40 to -0.10; P = .001) percentage points lower for non-Hispanic Black non-dual-eligible beneficiaries and 0.27 (95% CI, -0.45 to -0.10; P = .002) percentage points lower for non-Hispanic Black dual-eligible beneficiaries compared with the model-associated changes for non-Hispanic White non-dual-eligible beneficiaries. No association was found between the CJR model and a widening of the THR use gap among race/ethnicity and dual eligibility groups. CONCLUSIONS AND RELEVANCE Results of this study indicate that the CJR model was associated with a modest increase in the already substantial difference in TKR use among non-Hispanic Black vs non-Hispanic White beneficiaries; no difference was found for THR. These findings support the widespread concern that payment reform has the potential to exacerbate disparities in access to joint replacement care.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/standards
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Cohort Studies
- Elective Surgical Procedures/economics
- Elective Surgical Procedures/standards
- Elective Surgical Procedures/statistics & numerical data
- Eligibility Determination/standards
- Eligibility Determination/statistics & numerical data
- Female
- Healthcare Disparities/economics
- Healthcare Disparities/standards
- Healthcare Disparities/statistics & numerical data
- Humans
- Male
- Medicare/economics
- Medicare/standards
- Medicare/statistics & numerical data
- Race Factors
- Reimbursement Mechanisms
- Socioeconomic Factors
- United States
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Affiliation(s)
- Caroline P. Thirukumaran
- Department of Orthopaedics, University of Rochester, Rochester, New York
- Department of Public Health Sciences, University of Rochester, Rochester, New York
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Yeunkyung Kim
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Benjamin F. Ricciardi
- Department of Orthopaedics, University of Rochester, Rochester, New York
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Kevin A. Fiscella
- Department of Public Health Sciences, University of Rochester, Rochester, New York
- Department of Family Medicine, University of Rochester, Rochester, New York
- Center for Community Health and Prevention, University of Rochester, Rochester, New York
| | - Addisu Mesfin
- Department of Orthopaedics, University of Rochester, Rochester, New York
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Laurent G. Glance
- Department of Public Health Sciences, University of Rochester, Rochester, New York
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
- RAND Health, RAND, Boston, Massachusetts
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Guo Y, Murphy MSQ, Erwin E, Fakhraei R, Corsi DJ, White RR, Harvey ALJ, Gaudet LM, Walker MC, Wen SW, El-Chaâr D. Birth outcomes following cesarean delivery on maternal request: a population-based cohort study. CMAJ 2021; 193:E634-E644. [PMID: 33941522 PMCID: PMC8112636 DOI: 10.1503/cmaj.202262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Data on the effect of cesarean delivery on maternal request (CDMR) on maternal and neonatal outcomes are inconsistent and often limited by inadequate case definitions and other methodological issues. Our objective was to evaluate the trends, determinants and outcomes of CDMR using an intent-to-treat approach. METHODS We designed a population-based retrospective cohort study using data on low-risk pregnancies in Ontario, Canada (April 2012-March 2018). We assessed temporal trends and determinants of CDMR. We estimated the relative risks for component and composite outcomes used in the Adverse Outcome Index (AOI) related to planned CDMR compared with planned vaginal delivery using generalized estimating equation models. We compared the Weighted Adverse Outcome Score (WAOS) and the Severity Index (SI) across planned modes of delivery using analysis of variance. RESULTS Of 422 210 women, 0.4% (n = 1827) had a planned CDMR and 99.6% (n = 420 383) had a planned vaginal delivery. The prevalence of CDMR remained stable over time at 3.9% of all cesarean deliveries. Factors associated with CDMR included late maternal age, higher education, conception via in vitro fertilization, anxiety, nulliparity, being White, delivery at a hospital providing higher levels of maternal care and obstetrician-based antenatal care. Women who planned CDMR had a lower risk of adverse outcomes than women who planned vaginal delivery (adjusted relative risk 0.42, 95% confidence interval [CI] 0.33 to 0.53). The WAOS was lower for planned CDMR than planned vaginal delivery (mean difference -1.28, 95% CI -2.02 to -0.55). The SI was not statistically different between groups (mean difference 3.6, 95% CI -7.4 to 14.5). INTERPRETATION Rates of CDMR have not increased in Ontario. Planned CDMR is associated with a decreased risk of short-term adverse outcomes compared with planned vaginal delivery. Investigation into the long-term implications of CDMR is warranted.
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Affiliation(s)
- Yanfang Guo
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Malia S Q Murphy
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Erica Erwin
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Romina Fakhraei
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Daniel J Corsi
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Ruth Rennicks White
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Alysha L J Harvey
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Laura M Gaudet
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Mark C Walker
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Shi Wu Wen
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Darine El-Chaâr
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont.
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Swiatek PR, Weiner JA, Butler BA, McCarthy MH, Louie PK, Wolinsky JP, Hsu WK, Patel AA. Assessing the Early Impact of the COVID-19 Pandemic on Spine Surgery Fellowship Education. Clin Spine Surg 2021; 34:E186-E193. [PMID: 33017340 PMCID: PMC8140639 DOI: 10.1097/bsd.0000000000001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN This was a cross-sectional study. OBJECTIVE The objective of this study is to report the impact of COVID-19 on spine surgery fellow education and readiness for practice. SUMMARY OF BACKGROUND DATA COVID-19 has emerged as one of the most devastating global health crises of our time. To minimize transmission risk and to ensure availability of health resources, many hospitals have cancelled elective surgeries. There may be unintended consequences of this decision on the education and preparedness of current surgical trainees. MATERIALS AND METHODS A multidimensional survey was created and distributed to all current AO Spine fellows and fellowship directors across the United States and Canada. RESULTS Forty-five spine surgery fellows and 25 fellowship directors completed the survey. 62.2% of fellows reported >50% decrease in overall case volume since cancellation of elective surgeries. Mean hours worked per week decreased by 56.2%. Fellows reported completing a mean of 188.4±64.8 cases before the COVID-19 crisis and 84.1% expect at least an 11%-25% reduction in case volume compared with previous spine fellows. In all, 95.5% of fellows did not expect COVID-19 to impact their ability to complete fellowship. Only 2 directors were concerned about their fellows successfully completing fellowship; however, 32% of directors reported hearing concerns regarding preparedness from their fellows and 25% of fellows were concerned about job opportunities. CONCLUSIONS COVID-19 has universally impacted work hours and case volume for spine surgery fellows set to complete fellowship in the middle of 2020. Nevertheless, spine surgery fellows generally feel ready to enter practice and are supported by the confidence of their fellowship directors. The survey highlights a number of opportunities for improvement and innovation in the future training of spine surgeons. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Peter R. Swiatek
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Joseph A. Weiner
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Bennet A. Butler
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Michael H. McCarthy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Philip K. Louie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jean-Paul Wolinsky
- Department of Neurological Surgery, Northwestern University, Chicago, IL
| | - Wellington K. Hsu
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
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Maldonado-Marcos E, Caula-Freixa C, Planellas-Giné P, Rodríguez-Hermosa JI, López-Ben S, Delisau-Puig O, Codina Cazador A. [Impact of SARS-COV-2 pandemic on elective and emergency surgery in a university hospital]. Cir Esp 2021; 99:368-373. [PMID: 38620504 PMCID: PMC7402232 DOI: 10.1016/j.ciresp.2020.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/25/2020] [Indexed: 12/27/2022]
Abstract
Introduction SARS-CoV-2 pandemic has caused an important impact in our country and elective surgery has been postponed in most cases. There's not known information about the decreasing and impact on surgery. Mortality of surgical patients with SARS-CoV-2 infection is estimated to be around 20%. Methods We conducted prospective data recruitment of people inpatient in our Digestive and General Surgery section of Girona's University Hospital Dr. Josep Trueta from 03/14 to 05/11. Our objective is to analyze the impact that SARS-CoV-2 pandemic over elective and urgent surgery. Results During the peak occupation of our center Intensive Care Unit (303.8%) there was a reduction on elective (93.8%) and urgent (72.7%) surgery. Mortality of patients with SARS-CoV-2 infection who underwent surgery (n = 10) is estimated to be a 10%. An 80% of these patients suffer complications (sever complications in 30%). Conclusions The actual study shows a global reduction of the surgical activity (elective and urgent) during de SARS-CoV-2 pandemic. Global mortality of patients with SARS-CoV-2 infection are low, but the severe complications have been over the usual.
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Affiliation(s)
- Eloy Maldonado-Marcos
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Cèlia Caula-Freixa
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
| | - Pere Planellas-Giné
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
- Facultad de Medicina, Universidad de Girona, Girona, España
| | - José Ignacio Rodríguez-Hermosa
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
- Facultad de Medicina, Universidad de Girona, Girona, España
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Santiago López-Ben
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
- Facultad de Medicina, Universidad de Girona, Girona, España
| | - Olga Delisau-Puig
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Antoni Codina Cazador
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
- Facultad de Medicina, Universidad de Girona, Girona, España
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Maldonado-Marcos E, Caula-Freixa C, Planellas-Giné P, Rodríguez-Hermosa JI, López-Ben S, Delisau-Puig O, Codina Cazador A. Impact of SARS-COV-2 pandemic on elective and emergency surgery in a university hospital. Cirugía Española (English Edition) 2021. [PMID: 32819710 PMCID: PMC8062438 DOI: 10.1016/j.cireng.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction SARS-CoV-2 pandemic has caused an important impact in our country and elective surgery has been postponed in most cases. There is not known information about the decreasing and impact on surgery. Mortality of surgical patients with SARS-CoV-2 infection is estimated to be around 20%. Methods We conducted prospective data recruitment of people inpatient in our Digestive and General Surgery section of Girona's University Hospital Dr. Josep Trueta from 03/14 to 05/11. Our objective is to analyze the impact that SARS-CoV-2 pandemic over elective and urgent surgery. Results During the peak occupation of our center Intensive Care Unit (303.8%) there was a reduction on elective (93.8%) and urgent (72.7%) surgery. Mortality of patients with SARS-CoV-2 infection who underwent surgery (n=10) is estimated to be a 10%. An 80% of these patients suffer complications (sever complications in 30%). Conclusions The actual study shows a global reduction of the surgical activity (elective and urgent) during de SARS-CoV-2 pandemic. Global mortality of patients with SARS-CoV-2 infection are low, but the severe complications have been over the usual.
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Affiliation(s)
- Eloy Maldonado-Marcos
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España.
| | - Cèlia Caula-Freixa
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España; Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
| | - Pere Planellas-Giné
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España; Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España; Facultad de Medicina, Universidad de Girona, Girona, España
| | - José Ignacio Rodríguez-Hermosa
- Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España; Facultad de Medicina, Universidad de Girona, Girona, España; Unidad de Cirugía Endocrina, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Santiago López-Ben
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España; Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España; Facultad de Medicina, Universidad de Girona, Girona, España
| | - Olga Delisau-Puig
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Antoni Codina Cazador
- Servicio de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España; Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España; Facultad de Medicina, Universidad de Girona, Girona, España
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Liu S, Chen L, Zhu G, Shao Y, Yu S, Li W, Lv W. Analysis of risk factors for cesarean scar diverticulum: A STROBE-compliant case-control study. Medicine (Baltimore) 2021; 100:e25757. [PMID: 33907172 PMCID: PMC8084051 DOI: 10.1097/md.0000000000025757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 02/05/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The purpose of this study was to explore the relevant factors that affect the risk of cesarean scar diverticulum (CSD).A retrospective, case-control study was designed among women with a history of cesarean section (CS) who were admitted in Zhejiang Tongde Hospital from January 2017 to December 2019. Women with missing information were excluded. The basic clinical characteristics and the risk factors for CSD were assessed using univariate analysis and multivariate logistic regression analysis.A total of 216 women were analyzed, including 87 patients with CSD and 129 cases without CSD as control. Significant differences in number of CS, trial of labor (elective or urgent CS), CS interval, uterine position, intraoperative hemorrhage, and dysmenorrhea between CSD group and control group (P < .05). Multivariate logistic regression analysis showed that number of CS, trial of labor, interval of CS, and uterine position were independent risk factors of CSD.In women with a history of CS, multiple cesarean deliveries, elective CS, cesarean interval of less than 5 years, and retroflexed position of the uterus may be associated with an elevated risk of CSD.
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Saito MK, Quaresma M, Fowler H, Majano SB, Rachet B. Exploring socioeconomic differences in surgery and in time to elective surgery for colon cancer in England: Population-based study. Cancer Epidemiol 2021; 71:101896. [PMID: 33516139 DOI: 10.1016/j.canep.2021.101896] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/12/2020] [Accepted: 01/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND A persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential surgical care by SES. METHODS We analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010-2013). We examined patterns of presentation and surgery by SES, and whether socioeconomic differences exist in the length of time from diagnosis to elective major resection using linear regression. RESULTS Among a total of 68 169 patients with colon cancer, 21.0 % (3138/14 917) in the most affluent group had emergency presentation (EP) whereas 27.9 % (2901/10 386) in the most deprived. Among 45 332 (66.5 %) patients who underwent resection, the proportion of patients receiving urgent surgery (surgery before or ≤ 7 days of diagnosis) was higher in the most deprived group (39.9 %, 2685/6733) than the most affluent (35.4 %, 3595/10 146). Days from diagnosis to elective surgery (surgery > 7 days after diagnosis) ranged from 33.9 (95 % CI 33.1-34.8) in stage II to 38.2 (95 % CI 36.8-39.7) in stage I, but no socioeconomic differences in time were seen in all stages. CONCLUSIONS Time to elective surgery for colon cancer did not differ by SES, whereas a higher proportion among deprived patients tended to be diagnosed through EP and to receive urgent surgery. These results suggest that the waiting time target may not be an appropriate measure to assess access to cancer care. Reducing both EP and urgent surgery should be a key policy target.
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Affiliation(s)
- Mari Kajiwara Saito
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Manuela Quaresma
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Helen Fowler
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sara Benitez Majano
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Kumar A, Batwani V, Shaikh N. Continuing ophthalmology practice in crisis - Lessons from COVID-19 pandemic. Indian J Ophthalmol 2021; 69:995. [PMID: 33727477 PMCID: PMC8012953 DOI: 10.4103/ijo.ijo_260_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Batwani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nawazish Shaikh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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COVIDSurg Collaborative. COVID-19-related absence among surgeons: development of an international surgical workforce prediction model. BJS Open 2021; 5. [PMID: 33688956 DOI: 10.1093/bjsopen/zraa021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. METHODS An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). RESULTS Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7-12, this decreased to 9.2-13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. CONCLUSION This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.
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Abstract
Following the Presidential declaration of a national emergency, many health care organizations adhered to recommendations from the Centers for Medicare and Medicaid (CMS) as well as the American College of Surgeons (ACS) to postpone elective surgical cases. The transition to only emergent and essential urgent surgical cases raises the question, how and when will hospitals and surgery centers resume elective cases? As a large health care system providing multispecialty tertiary/quaternary care with across the Southeast United States, a collaborative approach to resuming elective surgery is critical. Numerous surgical societies have outlined a tiered approach to resuming elective surgery. The majority of these guidelines are suggestions which place the responsibility of making decisions about re-entry strategy on individual health care systems and practitioners, taking into account the local case burden, projected case surge, and availability of resources and personnel. This paper reviews challenges and solutions related to the resumption of elective surgeries and returning to the pre-COVID-19 surgical volume within an integrated health care system that actively manages 18 facilities, 111 operating rooms, and an annual operative volume exceeding 123,000 cases. We define the impact of COVID-19 across our surgical departments and outline the staged re-entry approach that is being taken to resume surgery within the health care system.
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Affiliation(s)
| | - Jeffrey S. Kneisl
- Atrium Health Musculoskeletal Institute
- Atrium Health Levine Cancer Institute
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Fliotsos MJ, Best MJ, Field MG, Srikumaran U, Repka MX, Woreta FA, Srikumaran D. Impact of reduced elective ophthalmic surgical volume on U.S. hospitals during the early coronavirus disease 2019 pandemic. J Cataract Refract Surg 2021; 47:345-351. [PMID: 32925656 PMCID: PMC7553026 DOI: 10.1097/j.jcrs.0000000000000410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/25/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE To estimate the financial impact of coronavirus disease 2019 (COVID-19)-related shutdowns on ophthalmic surgery performed at hospital outpatient departments (HOPDs) in the United States. SETTING Nationally representative sample of U.S. hospital payment and cost data. DESIGN Retrospective review and economic impact analysis. METHODS The Nationwide Ambulatory Surgery Sample (NASS) was used to identify ophthalmic surgical procedures and associated charges, which were performed at HOPDs. The highest volume elective ophthalmic procedures were identified. The total hospital cost and payment amount was calculated for each procedure using the Hospital Outpatient Prospective Payment System (OPPS) maintained by the Centers for Medicare & Medicaid Services. Net facility income (estimated payments less OPPS rates) was determined for each elective surgical procedure category and stratified by hospital teaching status. RESULTS In 2017, elective cataract, strabismus, and keratoplasty surgeries were performed 1 230 992 times at HOPDs. The total cost of these elective surgeries was 2350 million U.S. dollars (USD), with a total hospital payment of 3624 to 3786 million USD. This led to an estimated net income of 1278 to 1440 million USD overall to U.S. hospitals in the NASS dataset from elective ophthalmic surgery (approximately 107 to 120 million USD per month), with a larger proportion performed in teaching hospitals. CONCLUSIONS The cessation of elective ophthalmic surgeries at HOPDs during COVID-19 resulted in a significant loss of income for hospitals in the United States and teaching experiences for trainees at academic medical centers.
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Affiliation(s)
- Michael J Fliotsos
- From the Wilmer Eye Institute, The Johns Hopkins University School of Medicine (Fliotsos, Repka, Woreta, D. Srikumaran), Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine (Best, U. Srikumaran), Baltimore, Maryland, Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine (Field), Iowa City, Iowa, USA
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Kulle CB, Azamat IF, Vatansever D, Erus S, Tarim K, Akyoldas G, Gokler O, Deveci MA, Cakar N, Ergonul O, Agcaoglu O, Kiremit MC, Yavuz O, Kiris T, Unsaler S, Giray B, Korkmaz M, Dilege E, Kilic M, Cesur E, Solaroglu I, Altuntas O, Simsek A, Tanju S, Erkan M, Canda E, Sasani M, Hafiz AM, Kordan Y, Balik E, Bilge O, Bugra D, Taskiran C, Dilege S. Is elective cancer surgery feasible during the lock-down period of the COVID-19 pandemic? Analysis of a single institutional experience of 404 consecutive patients. J Surg Oncol 2021; 123:1495-1503. [PMID: 33621377 PMCID: PMC8013582 DOI: 10.1002/jso.26436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/23/2022]
Abstract
Background We aimed to assess the feasibility and short‐term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID‐19)‐free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. Materials and Methods This was a single‐center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS‐CoV‐2 infection and 30‐day pulmonary or non‐pulmonary related morbidity and mortality associated with SARS‐CoV‐2 disease. Results Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS‐CoV2 infection because of acute respiratory distress syndrome. The overall non‐SARS‐CoV2 related 30‐day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS‐CoV2 related 30‐day morbidity and mortality rates were 0.2% and 0.2%, respectively. Conclusions Under strict institutional policies and measures to establish a COVID‐19‐free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.
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Affiliation(s)
- Cemil Burak Kulle
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | | | - Dogan Vatansever
- Department of Obstetrics and Gynecology, School of MedicineKoc UniversityIstanbulTurkey
| | - Suat Erus
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Kayhan Tarim
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Goktug Akyoldas
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Ozan Gokler
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Mehmet Ali Deveci
- Department of Orthopedic Surgery and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, School of MedicineKoc UniversityIstanbulTurkey
| | - Onder Ergonul
- Department of Infectious Diseases, School of MedicineKoc UniversityIstanbulTurkey
| | - Orhan Agcaoglu
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Murat Can Kiremit
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Omer Yavuz
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Talat Kiris
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Selin Unsaler
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Burak Giray
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of MedicineKoc UniversityIstanbulTurkey
- Department of Obstetrics and GynecologyZeynep Kamil Training and Research HospitalIstanbulTurkey
| | - Murat Korkmaz
- Department of Orthopedic Surgery and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
| | - Ece Dilege
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Mert Kilic
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Ezgi Cesur
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Ihsan Solaroglu
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Ozan Altuntas
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Aykin Simsek
- Department of Orthopedic Surgery and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
| | - Serhan Tanju
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Mert Erkan
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Erdem Canda
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Mehdi Sasani
- Department of Neurosurgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Aysenur Meric Hafiz
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Yakup Kordan
- Department of Urology, School of MedicineKoc UniversityIstanbulTurkey
| | - Emre Balik
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Orhan Bilge
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Dursun Bugra
- Department of General Surgery, School of MedicineKoc UniversityIstanbulTurkey
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, School of MedicineKoc UniversityIstanbulTurkey
| | - Sukru Dilege
- Department of Thoracic Surgery, School of MedicineKoc UniversityIstanbulTurkey
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Ferreira J, Boto P. [Cancellations of Elective Surgeries on the Day of the Operation in a Portuguese Hospital: One Year Overview]. ACTA MEDICA PORT 2021; 34:103-110. [PMID: 33641703 DOI: 10.20344/amp.13437] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/27/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Cancellations of elective operations on the day of the surgery reflect the efficiency and quality within organisations, and have a significant clinical, social and economic impact, not only for the patient and their families, but also for healthcare institutions. This study assesses the extent of these cancellations in one public Portuguese hospital, through case quantification and identification of the causes, origin, as well as its predictability according to the sociodemographic variables of the patient and interventions used to decrease it. MATERIAL AND METHODS Non-experimental descriptive quantitative methodology - longitudinal and retrospective - of operation cancellation cases on the day of the surgery, from the 1st of January to the 31st of December 2018. RESULTS The rate of cancellations of elective surgeries on the same day of the operation was 2.9% with variations among different surgical specialties; cancelled operations are more frequent in female patients, in patients aged between 50 and 80 years old, physical status classified as II or III according to the American Society of Anesthesiology, and without anaesthetic pre assessment or preoperative consultations; the three most relevant causes for cancellations are: lack of operative time, scarcity of beds and/or medical equipment, and changes in health status; most of which can be avoided and are the responsibility of the institution. DISCUSSION Different reasons for cancellation of elective operations reflect a variety of upstream and downstream processes causing cancellation of surgeries and whose origin/imputability is related to both the institution and patients. CONCLUSION The rate of cancellations of elective surgeries on the same day of the operation is relatively low, but the causes are often preventable, thus justifying the generalization of cancellation reduction strategies.
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Affiliation(s)
- Joaquim Ferreira
- Serviço de Anestesiologia. Centro Hospitalar da Póvoa de Varzim/Vila do Conde. Póvoa de Varzim. Portugal
| | - Paulo Boto
- Departamento de Gestão de Organizações e Serviços de Saúde. Escola Nacional de Saúde Pública. Lisboa. Portugal
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Duarte A, Gouveia E Melo R, Lopes A, Rato JP, Valente J, Pedro LM. Lessons Learned from the Impact of the COVID-19 Pandemic in a Vascular Surgery Department and Preparation for Future Outbreaks. Ann Vasc Surg 2021; 73:97-106. [PMID: 33493593 PMCID: PMC7825916 DOI: 10.1016/j.avsg.2021.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 02/07/2023]
Abstract
Objectives This study aims to report the changes and adaptations of a vascular tertiary center during a global pandemic and the impact on its activity and patients. Methods We conducted a retrospective cohort study within the Vascular Surgery ward in Centro Hospitalar Universitário Lisboa Norte, Portugal. All data from surgical, inpatient and outpatient activity were collected from February to June 2020 and compared to the same 5-month period in 2018 and 2019. We ran a descriptive analysis of all data and performed statistical tests for the variation of procedures and admissions between February and June 2018 and the same time period in 2020. Results During the outbreak, our staff had to be readapted. Six nurses were transferred to COVID-19 units (out of a total of 33 nurses) while 1 of the 7 residents was transferred to an intensive care unit and 1 senior surgeon was put on prophylactic leave. In the outpatient clinic, there was an increase in the number of telemedicine consultations with a greater focus on first-time referrals and urgent cases. There was a significant increase in the total number of elective admissions whereas there were significantly less admissions from an emergency setting (+57% and −54%, respectively, P < 0.001). The vascular surgery team performed a total number of 584 procedures between February and June 2020 (−17.8% compared to 2018 and 2019), with a significant increase in the number of endovascular procedures (P < 0.001) and in the use of local and regional anesthesia (P < 0.001), especially in the Angio Suite (+600%, P < 0.001). Comparing with 2018 and 2019, the surgical team performed less outpatient procedures in early 2020. We reported a significant increase in the total number of procedures for patients with a chronic limb-threatening ischemia (CLTI) diagnosis (+21%, P < 0.001). We did not report significant changes in the proportion of other vascular conditions. Regarding mortality, we observed a 16% decrease in the intraoperative mortality (P 0.67). Conclusions In this study, we assessed the impact of the COVID-19 outbreak in daily activity during the contingency period. During the outbreak, there was an overall decline in outpatient clinics and inpatient admissions. Nevertheless, and despite the restrictions imposed by the pandemic and health authorities, we managed to maintain most procedures for most vascular diseases, particularly for CLTI urgent cases, without a significant increase in the mortality rate. Stringent protective measures for patient and staff or higher use of endovascular techniques and local anesthesia are some of the successful changes implemented in the department. These learned lessons are to be pursued as the pandemic evolves with future outbreaks of COVID-19, such as the current second outbreak currently spreading through Europe.
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Affiliation(s)
- António Duarte
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal.
| | - Ryan Gouveia E Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Alice Lopes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal
| | - João Pedro Rato
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal
| | - João Valente
- Anesthesiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
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Yigit B, Citgez B, Tanal M, Yetkin SG, Uludag M. Comparison of the management of emergency and oncological surgeries during the COVID-19 pandemic with the previous experience. A single-center retrospective study. Ann Ital Chir 2021; 92:323-329. [PMID: 33200752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM The aim of this study is to point out the changes and possible delay in diagnosis or treatment of malignancies and an added risk of COVID-19 exposure emerging from these interventions, as well as to underline the increase of surgical demand once the pandemic measures are eased. METHODS This study is a retrospective review of the patients operated between 11.03.2020 and 31.05.2020 in a center with a high incidence of COVID-19 infection during the pandemic. The numbers of emergency, elective and oncological surgeries as well as the increasing or decreasing trends of these interventions between March 11 and May 31 of previous years were compared with the corresponding period of 2020 or in other words the pandemic period. RESULTS From March 11 to May 31, 2020 there was a progressive reduction in surgical activity, with only 195 operations: 61(31,28%) on a scheduled basis for tumor pathology, 59(30,25%) for benign pathology and 75(38,46%) for emergency indications. When the surgical trends of previous years are considered, all types of oncological surgeries decreased significantly in pandemic period March 11 to May 31, 2020. CONCLUSION One of the most striking changes in medical care settings during the COVID-19 pandemic was observed in surgical management strategies. The most significant among these were the limitation of elective surgical procedures and the prioritization of emergency or non-delayed oncological operations. One may speculate that the standstill of elective surgeries including the oncological surgeries might have long term impacts on the clinical outcomes of patients as well as the healthcare workers and organizations. KEY WORDS COVID-19, Emergency, Oncology, Pathology, SARS-CoV-2, Surgery.
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Laäs DJ, Farina Z, Bishop DG. Effect of COVID-19 pandemic decisions on tertiary-level surgical services in Pietermaritzburg, KwaZulu-Natal Province, South Africa. S Afr Med J 2020; 0:13182. [PMID: 33334391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. OBJECTIVES To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa. METHODS A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted. RESULTS Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques. CONCLUSIONS The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.
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Affiliation(s)
- D J Laäs
- Discipline of Anaesthesiology and Critical Care, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Toia F, Romeo M, Abate M, Avarotti E, Battiston B, Bruno G, Cannavò F F, Casamichele C, Colonna M, Catena N, Cherubino M, Coppolino S, Galvano N, Giuca G, Gullo S, Internullo G, Lazzerini A, Marcoccio I, Maruccia M, Melloni C, Pajardi G, Pugliese P, Risitano G, Spata G, Tripoli M, Troisi L, Tos P, Cordova A. Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions. Hand Surg Rehabil 2020; 40:139-144. [PMID: 33309793 PMCID: PMC7836699 DOI: 10.1016/j.hansur.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/03/2022]
Abstract
The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.
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Affiliation(s)
- F Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy.
| | - M Romeo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - M Abate
- SSD di Ortopedia, ARNAS Garibaldi, Presidio di Nesima, Via Palermo 636, 95123, Catania (CT), Italy
| | - E Avarotti
- Department of Orthopedics and Traumatology, A.R.N.A.S. Piazza Santa Maria di Gesù 5, 95124, Catania (CT), Italy
| | - B Battiston
- Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, AOU Città della Salute e della Scienza, Via Nizza 138, 10126, Torino (TO), Italy
| | - G Bruno
- Department of Orthopedics and Traumatology, A.O. Vittorio Emanuele, Via Plebiscito 632, 95122, Catania (CT), Italy
| | - F Cannavò F
- U.O.S.D. Plastic Surgery A.O. Papardo, Contrada Papardo, 98158, Messina (ME), Italy
| | - C Casamichele
- Department of Orthopedics and Traumatology, A.O. "G. Paolo II", Contrada Cisternazzi, 97010, Ragusa (RG), Italy
| | - M Colonna
- Plastic Surgery Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria1, 98124, Messina (ME), Italy
| | - N Catena
- Pediatric Orthopedic and Traumatology Unit, Children's Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Via Spalto Marengo 46, 15121, Alessandria (AL), Italy
| | - M Cherubino
- Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Via Ravasi 2, 21100, Varese (VA), Italy
| | - S Coppolino
- Hospital S. Vincenzo, Contrada Sirina, 98039, Taormina (ME), Italy
| | - N Galvano
- Department of Orthopedics and Traumatology A.O.U.P." Paolo Giaccone", Via Del Vespro 127, 90127 Palermo (PA), Italy
| | - G Giuca
- Department of Orthopedics Ospedale Maggiore, Via Resistenza Partigiana, 97015, Modica (RG), Italy
| | - S Gullo
- Department of Hand Surgery and Traumatology, A.R.N.A.S., Piazza Nicola Leotta 4, 90127, Palermo (PA), Italy
| | - G Internullo
- Department of Orthopedics, Ospedale Gravina, Via Portosalvo 9, 95041, Caltagirone (CT), Italy
| | - A Lazzerini
- Hand Surgery and Microsurgery Unit, IRCCS Humanitas Clinical Institute, Via Alessandro Manzoni 6, 20089, Milano (MI), Italy
| | - I Marcoccio
- Orthopedic Microsurgery and Upper Limb Surgery, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia (BS), Italy
| | - M Maruccia
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70122, Bari (BR), Italy
| | - C Melloni
- Plastic and Reconstructive Surgery A.O. P. Borsellino, Contrada Cardilla 1, 91025, Marsala (TP), Italy
| | - G Pajardi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Pugliese
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - G Risitano
- ABC Medical, Via Porto Salvo 2, 98121, Messina (ME), Italy
| | - G Spata
- Hand Surgery, Polyclinic Morgagni, Via del Bosco 105, 95030, Catania (CT), Italy
| | - M Tripoli
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - L Troisi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Tos
- Hand Surgery and Reconstructive Microsurgery Unit, Orthopedic Institute G. Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122, Milano (MI), Italy
| | - A Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
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Abstract
This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic. In particular, the prolonged exposure and manipulation of the nasal and oral cavities portend a high risk of viral transmission. We discuss evidence-based recommendations to mitigate the risk of viral transmission through novel techniques and device implementation as well as increasing conservative management of certain pathologies.
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Affiliation(s)
- Morgan E Davis
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego School of Medicine, 9350 Campus Point Drive, Mail Code 0970, La Jolla, CA 92037, USA
| | - Carol H Yan
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego School of Medicine, 9350 Campus Point Drive, Mail Code 0970, La Jolla, CA 92037, USA.
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Wittayanakorn N, Nga VDW, Sobana M, Bahuri NFA, Baticulon RE. Impact of COVID-19 on Neurosurgical Training in Southeast Asia. World Neurosurg 2020; 144:e164-e177. [PMID: 32805466 PMCID: PMC7428452 DOI: 10.1016/j.wneu.2020.08.073] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neurosurgery departments worldwide have been forced to restructure their training programs because of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we describe the impact of COVID-19 on neurosurgical training in Southeast Asia. METHODS We conducted an online survey among neurosurgery residents in Indonesia, Malaysia, Philippines, Singapore, and Thailand from May 22 to 31, 2020 using Google Forms. The 33-item questionnaire collected data on elective and emergency neurosurgical operations, ongoing learning activities, and health worker safety. RESULTS A total of 298 of 470 neurosurgery residents completed the survey, equivalent to a 63% response rate. The decrease in elective neurosurgical operations in Indonesia and in the Philippines (median, 100% for both) was significantly greater compared with other countries (P < 0.001). For emergency operations, trainees in Indonesia and Malaysia had a significantly greater reduction in their caseload (median, 80% and 70%, respectively) compared with trainees in Singapore and Thailand (median, 20% and 50%, respectively; P < 0.001). Neurosurgery residents were most concerned about the decrease in their hands-on surgical experience, uncertainty in their career advancement, and occupational safety in the workplace. Most of the residents (n = 221, 74%) believed that the COVID-19 crisis will have a negative impact on their neurosurgical training overall. CONCLUSIONS An effective national strategy to control COVID-19 is crucial to sustain neurosurgical training and to provide essential neurosurgical services. Training programs in Southeast Asia should consider developing online learning modules and setting up simulation laboratories to allow trainees to systematically acquire knowledge and develop practical skills during these challenging times.
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Affiliation(s)
- Nunthasiri Wittayanakorn
- Division of Neurosurgery, Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | | | - Mirna Sobana
- Division of Pediatric Neurosurgery, Hasan Sadikin Hospital/Padjadjaran University, Bandung, West Java, Indonesia
| | | | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, and Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila, Philippines.
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Sutherland L, Hastie J, Takayama H, Furuya Y, Hochman B, Kelley N, Kurlansky P, McLaughlin D, Raza ST, Scully B. Low rate of health care-associated transmission of coronavirus disease 2019 (COVID-19) in the epicenter. J Thorac Cardiovasc Surg 2020; 161:e235-e237. [PMID: 33218758 PMCID: PMC7428777 DOI: 10.1016/j.jtcvs.2020.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Lauren Sutherland
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Jonathan Hastie
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Yoko Furuya
- Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Beth Hochman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | | | - Paul Kurlansky
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | | | - S Tasnim Raza
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Brian Scully
- Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
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Cullen S, Wrafter PF, Jones D, Regan PJ, Kelly JL, Hussey AJ, McInerney NM. Plastic surgery procedure unit: A streamlined care model for minor and intermediate procedures: A cost-benefit analysis. J Plast Reconstr Aesthet Surg 2020; 74:192-198. [PMID: 33129699 DOI: 10.1016/j.bjps.2020.08.100] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/28/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The advent of wide-awake local anaesthesia has led to a reduced need for main theatre for trauma and elective plastic procedures. This results in significant cost-benefits for the institution. This study aims to show how a dedicated 7 days/ week plastic surgery procedural (PSP) unit, performing both elective and trauma surgeries, can lead to significant cost-benefits for the institution. METHODS Retrospective review of all cases performed in the PSP unit between 1 September and 31 August 2018. We utilised hospital directory admissions data and the hospital's intranet operating theatre system to calculate hospital days saved. Cost analysis was performed using Saolta financial data. RESULTS A total of 3058 operations were performed. Of these operations, 2388 cases were elective and 670 were trauma cases. The average waiting time for trauma cases for main operating theatre was 1.4 days, saving a total of 487 hospital days. The total savings associated with hospital bed days were €347,861. The estimated resource savings from performing a procedure in PSP compared with main theatre with regional anaesthesia were €529.00 and €391.00 without regional anaesthesia. The cost saved due to resources was therefore €337,226. The total cost-benefit associated with performing surgeries in PSP including hospital days and resources saved was calculated as €685,087. CONCLUSION This study shows the benefit of performing elective and trauma operations in minor procedure units such as PSP. PSP results in a more efficient service, reducing waiting times for surgery, shorter hospital stay, reduced operating cost and an overall significant cost saving.
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Affiliation(s)
- Shane Cullen
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland.
| | - Paula F Wrafter
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland
| | - Deirdre Jones
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland
| | - Padraic J Regan
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland
| | - Jack L Kelly
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland
| | - Alan J Hussey
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland
| | - Niall M McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Newcastle Road, Co. Galway, H91 YR71, Republic of Ireland
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50
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Bernardino R, Gil M, Andrade V, Severo L, Alves M, Papoila AL, Campos Pinheiro L. What has changed during the state of emergency due to COVID-19 on an Academic Urology Department of a Tertiary Hospital in Portugal. Actas Urol Esp 2020; 44:604-610. [PMID: 32843150 PMCID: PMC7381920 DOI: 10.1016/j.acuro.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Objetivo Comparar la actividad del Servicio de Urología de un Hospital Universitario Portugués durante el estado de alarma y el periodo equivalente del año anterior. Comparamos el número de consultas electivas y pruebas diagnósticas urológicas, el número y el tipo de cirugías electivas, así como las características demográficas de los pacientes y las principales causas de ingreso al Servicio de Urgencias (SU) de Urología durante los dos periodos mencionados. Materiales y métodos Los datos de 691 pacientes que acudieron a urgencias desde el 18 de marzo de 2020 hasta el 2 de mayo de 2020 -y del mismo periodo del año anterior- se recogieron del software medico institucional. Los datos recopilados fueron edad, sexo, fecha de visita al servicio de urgencias, derivación desde otros hospitales, color del triaje, causa del ingreso, diagnóstico al alta y la necesidad de cirugía de urgencia u hospitalización. Con la intención de identificar las asociaciones entre las variables demográficas y clínicas con el hecho de haber sido sometido a una cirugía de urgencia (variable), se aplicaron modelos de regresión logística. Resultados El análisis multivariante mostró asociación entre el sexo del paciente con el hecho de ser sometido a una cirugía, con una disminución del 65,6% en las probabilidades para el género masculino. El periodo (COVID versus sin-COVID) no mostró una asociación significativa con la cirugía. Conclusión Nuestro departamento experimentó una reducción importante en la actividad. También observamos una reducción de las causas urgentes para acudir a los servicios de urgencias considerados menos graves. El porcentaje de casos que requirieron cirugía de urgencia y hospitalización fue mayor durante el periodo COVID.
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Affiliation(s)
- R Bernardino
- Urology Department, Central Lisbon Hospital Center, Lisbon, Portugal.
| | - M Gil
- Urology Department, Central Lisbon Hospital Center, Lisbon, Portugal
| | - V Andrade
- Urology Department, Central Lisbon Hospital Center, Lisbon, Portugal
| | - L Severo
- Urology Department, Central Lisbon Hospital Center, Lisbon, Portugal
| | - M Alves
- Epidemiology and Statistics Unit, Research Center, Central Lisbon Hospital Center, Lisbon, Portugal
| | - A L Papoila
- Epidemiology and Statistics Unit, Research Center, Central Lisbon Hospital Center, Lisbon, Portugal
| | - L Campos Pinheiro
- Urology Department, Central Lisbon Hospital Center, Lisbon, Portugal
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