ABSTRACT
Introduction The onset of the COVID-19 pandemic in early 2020 triggered reorganisation of hospital departments around the world as resources were configured to prioritise critical care. In spring 2020, NHS England issued national guidance proposing acceptable time intervals for postponing different types of surgical procedures for patients with cancer and other conditions. The 'Consider-19' study sought to investigate prioritisation decisions in practice, with in-depth examination of colorectal cancer surgery as a case-study, given recommendations that these procedures could be delayed by up to 12 weeks. Methods Twenty-seven semi-structured interviews were conducted with healthcare professionals between June - November 2020. A key informant sampling approach was used, followed by snowballing to achieve maximum regional variation across the UK. Data were analysed thematically using the constant comparison approach. Results Interviewees reported a spectrum of perceived disruption to colorectal cancer surgery services in the early phase of the pandemic, with some services reporting greater scarcity of resources than others. Nonetheless, all reported a need to prioritise patients based on local judgments. Prioritisation was framed by many as unfamiliar territory, requiring significant deliberation and emotional effort. Whilst national guidance provided a framework for prioritising, it was largely left to local teams to devise processes for prioritising within surgical specialities and then between different specialities, resulting in much local variation in practice. Discussion The pandemic necessitated a significant change in practice as surgeons, in a tense and uncertain situation, found themselves having to navigate clinically, emotionally, and ethically- charged decisions about how best to use limited surgical resources. Whilst unavoidable, many felt uncomfortable with the task and the consequences for their patients. The findings point to a need to better support surgeons tasked with prioritising patients and raise questions about who should be involved in this activity.
ABSTRACT
Introduction: For students and trainees, COVID-19 has restricted opportunities for training and development. We sought to develop a virtual network to facilitate remote engagement and training in surgical research during COVID-19. RoboSurg aims to conduct a series of systematic reviews, to summarise and critique the reporting of studies of robot-assisted surgery across seven upper gastrointestinal procedures. Methods: A protocol was developed based on previously published work. Searches were undertaken to identify studies evaluating robotic pancreas, liver, oesophagus, stomach, gallbladder, bariatric and antireflux surgery. Participants were identified through social media and collaborative research networks. Abstracts were screened for inclusion by two participants. Data extraction is completed by teams of collaborators, entered into a bespoke REDCap database and verified by senior team member. Changes are logged, with rationale and feedback provided to collaborators and reviewed by a third reviewer to assess consistency. Results of each review will be summarised in narrative syntheses. Results: A total of 134 collaborators have registered, with 73 active participants. Collaborators range from second year medical students to surgical registrars across the UK. To date, 9444 abstracts and 1653 full texts have been screened with 422 eligible articles identified. Data extraction for two systematic reviews, including 193 articles, has been completed using this approach. Conclusion: RoboSurg has developed a network and methodological framework for the remote conduction of complex systematic reviews, which can be utilised to engage and train students and trainees in surgical research.
ABSTRACT
Introduction: Diagnosing appendicitis remains challenging, despite being the most common surgical emergency. We conducted a single-centre mixed method quality improvement project to assess the validity of a diagnostic algorithm for appendicitis and the diagnostic impact of increasing cross-sectional imaging during the Covid-19 pandemic. Method: Adult histology reports and preoperative imaging data were retrospectively retrieved for patients operated on between 1/7/19-31/ 12/19 ('baseline data') and an appendicitis diagnostic algorithm was developed. Imaging and risk stratification data were prospectively collected, as part of a national audit, between 20/03/30-23/6/20 for all adult appendicitis patients. This data was used to evaluate the efficacy of the proposed diagnostic algorithm. Use of imaging and histological diagnoses was compared between datasets. Results: 194 patients were included across both time periods. The rate of cross-sectional imaging increased from 36.6% to 76% and the normal appendicectomy rate (NAR) decreased from 5.22% to 2.4%. Thirty-six percent of patients in the latter time period were not managed in accordance with the proposed algorithm. The proposed diagnostic algorithm may have prevented up to 87.5% of normal appendicectomies across both time periods. Conclusions: Increasing cross-sectional imaging was associated with a decrease in the NAR. The use of the proposed diagnostic algorithm may have reduced the NAR further.