ABSTRACT
Introduction/Background ∗ ERAS (Enhanced Recovery after Surgery) is a multimodal perioperative care pathway designed to achieve early recovery after surgical procedures. This study aimed to analyse the feasibility of ERAS in the era of pandemic and to find its effect on the post-operative outcome of patients undergoing surgery for gynaecological cancer during the COVID pandemic Methodology This observational study was done on patients who underwent gynaecological cancer surgery during COVID pandemic in a tertiary cancer centre in South India. Data was collected including patient demographics, nature of surgery, adherence to each of the components of ERAS programme and outcomes. Post operative complications were graded according to the Clavien-Dindo classification Result(s)∗ 152 patients were included in the study period from June to December 2020. 85 patients had cancer ovary, 59 cancer endometrium, 6 cancer cervix and 1 cancer vulva and 7 patients had benign tumours. In the pre operative component of ERAS protocols,82% patients received pre surgery counselling, 97% received thromboembolic prophylaxis, 94% received carbohydrate loading and none of the patients received mechanical bowel preparation. 8% received blood components during and after surgery. In the post operative phase on Day 1, 62% patients had urinary catheter removed, 88% received normal diet and 92% had early ambulation. The complication rate was 26%, but majority 79% had grade 1 and 2 complications. There was one postoperative mortality due to sepsis. The mean hospital stay was 6.6 days. Conclusion∗ The study confirms the feasibility and benefits of following ERAS pathway in enhancing patient recovery during COVID pandemic.
ABSTRACT
Objectives: To assess the impact of the COVID pandemic on gynecologic oncology surgical practice and postoperative morbidity in a tertiary cancer Centre as compared to the year before the pandemic. Method: Retrospective observational study of all patients undergoing surgery for gynecological malignancies in Regional Cancer Centre, Thiruvananthapuram during the first 6 months of the COVID pandemic between March 1, 2020, and August 31, 2020, compared to patients undergoing surgery during the same period in 2019. Clinical and demographic data including comorbidities, stage of cancer, COVID-19 status, surgical procedure, postoperative stay and morbidity related to surgery were obtained from hospital records. Results: The total number of surgeries done during the study period in 2020 was 77 compared to 122 in 2019. Three patients had tested positive for COVID 19 and had their surgeries one month after testing negative.2.6% of patients had minimally invasive surgeries compared to 5.7% in 2019. Complex procedures comprised 23.4%in 2020 compared to 20.5% in 2019. A higher percentage of patients with ovarian cancer underwent neoadjuvant chemotherapy in 2020 (93.3% vs 80.6%). Intraoperative blood transfusions were given for 14.3% vs 4.9%. Post-operative ventilation was used for 5.2% vs 3.3%. Unplanned readmissions were 5.2% vs 1.6%. There was one postoperative mortality in 2020 who was a patient who tested positive in the preoperative period and had a bowel perforation and sepsis. Conclusions: Even with all the restraints imposed by the pandemic, we continued to do complex surgeries including minimally invasive procedures. Although the postoperative complications were more in number in 2020, a statistically significant difference was seen only in case of intraoperative blood transfusions and prolonged ileus.
ABSTRACT
Introduction: The COVID-19 pandemic has wreaked havoc on the presentation, care and outcomes of patients with acute cerebrovascular and cardiovascular conditions. We sought to measure the national impact of COVID-19 on the care for acute ischemic stroke (AIS) and acute myocardial infarction (AMI). Methods: In this retrospective, observational study, we used the Premier Healthcare Database to evaluate the changes in the volume of care and hospital outcomes for AIS and AMI in relation to the pandemic. The pandemic months were defined from March 1, 2020- April 30, 2020 and compared to the same period in the year prior. Outcome measures were volumes of hospitalization and reperfusion treatment for AIS and AMI (including intravenous thrombolysis [IVT] and/or mechanical thrombectomy [MT] for AIS and percutaneous coronary interventions [PCI] for AMI) as well as inhospital mortality, hospital length of stay (LOS) and hospitalization costs were compared across a 2- month period at the height of the pandemic versus the corresponding period in the prior year. Results: There were 95,453 AIS patients across 145 hospitals and 19,744 AMI patients across 126 hospitals. There was a significant nation-wide decline in the absolute number of hospitalizations for AIS (-38.94%;95%CI,-34.75% to -40.71%) and AMI (-38.90%;95%CI,-37.03% to -40.81%) as well as IVT (-30.32%;95%CI,-27.02% to -33.83%), MT (-23.54%;95%CI,-19.84% to -27.70%), and PCI (-35.05%;95%CI,-33.04% to -37.12%) during the first two months of the pandemic. This occurred across low-, mid-, and high-volume centers and in all geographic regions. Higher in-hospital mortality was observed in AIS patients (5.7% vs.4.2%, p=0.0037;OR 1.41,95%CI 1.1-1.8) but not AMI patients. A shift towards an increase in the proportion of admitted AIS and AMI patients receiving reperfusion therapies suggests a greater clinical severity among patients that were hospitalized for these conditions during the pandemic. A shorter length of stay (AIS: -17%, AMI: -20%), and decreased hospitalization costs (AIS: -12%, AMI: -19%) were observed. Conclusions: Our findings shed light on the combined health outcomes and economic impact the COVID-19 pandemic has had on acute stroke and cardiac emergency care.