ABSTRACT
Aim: To quantify the impact of the pandemic on colectomy rates and compare post-operative outcomes to pre-pandemic levels. Method(s): A systematic review was conducted as per the PRISMA statement. We interrogated, MEDLINE, EMBASE, the Cochrane library and Web of Science for studies focusing on colorectal resections in adults and/or their outcomes during the Covid-19 pandemic. Studies not reporting a pre-pandemic comparison were excluded. Meta analyses were performed on STATA using a random effects model. Heterogeneity was assessed using the I2 statistic. Result(s): 1976 articles were identified and after removing duplicates and screening full text articles, 19 met the inclusion criteria from 11 countries with one multi-national cohort. A total of 30354 patients were included in this study, 18856 pre-pandemic and 11498 in the pandemic. In total 18 studies reported pre and post-pandemic resection numbers. There was a mean reduction of 22.3% in colorectal resections overall comparing pre and pandemic periods. 10 studies reported on elective colorectal cancer resections, with a mean reduction of 27.9% during the pandemic period. Only 3 studies reported cases of elective benign colectomies, with a mean reduction of 49.1% during the pandemic period. On meta-analysis the overall 30 day mortality risk comparing the pre and pandemic period was not significantly different (RR1.29 95% c.i. 0.88 - 1.87, p = 0.124). We found no statistically significant differences in readmission within 30days, use of laparoscopic surgery or stoma formation between the pre and pandemic periods. Conclusion(s): There was a reduction in the number of colectomies performed world-wide. Despite pressures on resources and national guidelines deviating from best practice, post-operative outcomes appear not to be significantly affected. This analysis may be limited by inadequate powering or misrepresentative sampling. Further work may interrogate national databases to accurately describe resectional colorectal surgery during the pandemic.
ABSTRACT
Purpose: Early in the coronavirus pandemic, guidelines and consensus have been proposed for the management of various general surgical emergencies to help surgeons serve the best interests of patients during an unprecedented time. There has been an agreement that certain conditions such as acute appendicitis should be managed conservatively with antibiotics whereas strong emphasis was put on the importance of timely surgical intervention on perianal and other superficial abscesses. Methods: Using ICD-10 codes, we investigated the impact of COVID-19 on surgical admissions due to perianal, pilonidal abscesses and acute appendicitis as comparison between March and November in 2020 and compared it to the same period in 2019. Results: The total number of surgical admissions due to perianal and pilonidal abscesses decreased by 22.5 and 31.7%, respectively, compared to the same period in 2019. Most of the decline was noted during the first wave, from March to July. Whereas acute appendicitis admissions remained comparatively constant between 2019 and 2020. Conclusion: Despite guidance regarding operative management of abscesses during the pandemic, the total number of surgical admissions due to perianal and pilonidal abscesses was reduced in comparison to the same period in 2019. Most of the decline was noted during the first wave, from March to July. This might result in higher rate of complications presenting at a later time.
ABSTRACT
This paper is an exploration of refugee young peoples’ narratives about their lives and experiences during the COVID-19 pandemic in Melbourne. Intersectionality is used as a method and analytical tool to interpret these experiences and show how young people have adapted during this time, taking on roles as navigators, carers, providers, and innovators. The article highlights that the roles young people adopted through the pandemic are very similar to those undertaken by young people in their pre arrival to Australia. The research points to the importance of involving refugee young people in settlement and public health initiatives. Finally, it is argued that we need to recognise refugee young people as experts in their own complex experience, valued partners in settlement, future leadership, and potential change makers. © 2021, Griffith University. All rights reserved.