Impact of COVID-19 lockdown on postoperative morbidity after hepatectomy: a propensity-score matching study on a national French database

Background SARS-CoV-2 pandemic impact on management of liver malignancies worldwide is unknown. This study aimed to determine the impact of lockdown on patient clinical pathways and postoperative morbi-mortality. Methods This study evaluated all adults' hospital stays for liver tumour between 2019 and 2021 from national French discharge database. Primary outcome was clinical pathway, especially surgical care and postoperative outcomes, between patients admitted during COVID-19 lockdown periods (Lockdown group) and during the same periods of 2019 and 2021 (Control groups). Results Overall population included 58508 patients: 18907 patients in the Lockdown group, 20045 in the 2019 Control group and 19556 in the 2021 Control group. Surgical activity decreased by 11.6% during Lockdowns, with 1514 (8.0%) of patients in Lockdown group treated by surgery, 1514 (8.6%) in 2019 Control group (p<0.001) and 1466 (7.4%) in 2021 Control group. Chemotherapy was more considered during the lockdown (p<0.001). More patients were operated in small-volume centers during the lockdown (34%vs.32%vs.32%, p=0.034) and less were hospitalized in highly populated regions (p<0.001). Postoperative morbidity (47%vs.47%vs.47%, p=0.90) and mortality (3.3% vs. 3.6% vs. 3.1%, p=0.80) were comparable in the three periods, with no influence of lockdowns on morbidity (RR=0.94, CI95%=0.81-1.09, p=0.40) or mortality (OR=1.12, CI95%=0.72-1.74, p=0.6). Postoperative pulmonary (17%vs.13%, p=0.024) and septic complications (20%vs.15%, p=0.022) were significantly higher during the first lockdown compared to the second. Conclusion This study provides a French overview of liver malignancies management during the COVID-19 pandemic. Surgical activity has decrease by 11.6%, moreover in the high-volume centers, with no impact on postoperative morbidity and mortality.

Airborne transmission of SARS-Cov2: What consequences for digestive endoscopy?

The SARS-Cov-2 disease disrupted essential hospital procedures, such as gastrointestinal (GI) endoscopy, due to concerns about air transmission and the risk of exposing health care workers. With the spread of the pandemic, air transmission was considered as the main source of SARS-Cov2 transmission. This raised the problem of transmission by aerosolization of viral particles in operating rooms as well as endoscopy units. This is in line with the known airborne transmission of many other respiratory viruses. The risk of SARS-Cov-2 transmission during GI endoscopy was initially reduced by controlled measures, involving personal protections (mask…), restricted access to endoscopy rooms, and detection of infected patients. Gastrointestinal endoscopy generates aerosols, which may carry viruses. In addition, the endoscopy system may facilitate the diffusion of virus particles or fomites considering the forced-air cooling system used to maintain a stable temperature inside the box (25°C). The volume of air that goes through the light source box is high (240-300 m3 for a 1-h period). Moreover, the light system contains an air pump to inflate air inside the gut lumen. In order to isolate people from hazard, different levels of protection and solutions to avoid airborne transmission of microorganisms should be proposed, such as the reinforcement of personal protective equipment, the change in the way people work and engineering control of the risk.

A new system to prevent SARS-CoV-2 and microorganism air transmission through the air circulation system of endoscopes.

Background and study aims Evidence for the modes of transmission of SARS-CoV-2 remains controversial. Recently, the potential for airborne spread of SARS-CoV-2 has been stressed. Air circulation in gastrointestinal light source boxes and endoscopes could be implicated in airborne transmission of microorganisms. Methods The ENDOBOX SC is a 600 × 600 mm cube designed to contain any type of machine used during gastrointestinal endoscopy. It allows for a 100-mm space between a machine and the walls of the ENDOBOX SC. To use the ENDOBOX SC, it is connected to the medical air system and it provides positive flow from the box to the endoscopy room. The ENDOBOX SC uses medical air to inflate the digestive tract and to decrease the temperature induced by the microprocessors or by the lamp. ENDOBOX SC has been investigated in different environments. Results An endoscopic procedure performed without ventilation was interrupted after 40 minutes to prevent computer damage. During the first 30 minutes, the temperature increased from 18 °C to 31 °C with a LED system. The procedure with fans identified variations in temperature inside the ENDOBOX SC from 21 to 26 °C (±â€Š5 °C) 1 hour after the start of the procedure. The temperature was stable for the next 3 hours. Conclusions ENDOBOX SC prevents the increase in temperature induced by lamps and processors, allows access to all necessary connections into the endoscopic columns, and creates a sterile and positive pressure volume, which prevents potential contamination from microorganisms.

Air circulation in a gastrointestinal light source box and endoscope in the era of SARS-CoV-2 and airborne transmission of microorganisms.

Background and study aims The role that air circulation through a gastrointestinal endoscopy system plays in airborne transmission of microorganisms has never been investigated. The aim of this study was to explore the potential risk of transmission and potential improvements in the system. Methods We investigated and described air circulation into gastrointestinal endoscopes from Fujifilm, Olympus, and Pentax. Results The light source box contains a lamp, either Xenon or LED. The temperature of the light is high and is regulated by a forced-air cooling system to maintain a stable temperature in the middle of the box. The air used by the forced-air cooling system is sucked from the closed environment of the patient through an aeration port, located close to the light source and evacuated out of the box by one or two ventilators. No filter exists to avoid dispersion of particles outside the processor box. The light source box also contains an insufflation air pump. The air is sucked from the light source box through one or two holes in the air pump and pushed from the air pump into the air pipe of the endoscope through a plastic tube. Because the air pump does not have a dedicated HEPA filter, transmission of microorganisms cannot be excluded. Conclusions Changes are necessary to prevent airborne transmission. Exclusive use of an external CO 2 pump and wrapping the endoscope platform with a plastic film will limit scatter of microorganisms. In the era of pandemic virus with airborne transmission, improvements in gastrointestinal ventilation systems are necessary to avoid contamination of patients and health care workers.

Impact of the COVID-19 pandemic on the management of cancer patients: the experience of the cancer outpatients department of a university hospital in Paris.

Cancer patients are a highly vulnerable group in the COVID-19 pandemic and it has been necessary for oncology units to adapt to this unexpected situation. We present our management of outpatients with cancer during the pandemic. We applied two major adaptations: extending the intervals between injections for maintenance therapy and protocol adaptation for patients with comorbidities. Between 17 March and 30 April 2020, 406 patients were treated in our outpatients department. Protocols were adapted for 94 (23.1%) patients. Among them, 49% had an extended interval between treatment administrations, 22.3% had modified protocols to reduce toxicity, 20.2% had therapeutic interruptions and 5.3% did not receive their treatment because of a COVID-19 infection. Overall, protocol adaptations concerned more than 20% of the patients. This pandemic was an opportunity for oncologists to re-examine the risk versus benefit balance of administering immunosuppressive treatment and highlighted that oncology daily routine should not be applied automatically.