ABSTRACT
Hintergrund Operative Eingriffe bei an „coronavirus disease 2019“ (COVID‑19) erkrankten Patienten sind unter strengen Hygiene- und Schutzmaßnahmen möglich und werden inzwischen regelhaft durchgeführt. In dieser Arbeit soll geprüft werden, mit welchem Mehraufwand dies verbunden ist. Material und Methoden Es erfolgte die strukturierte Auswertung von 71 am Universitätsklinikum Augsburg zwischen dem 01.11.2020 und 31.12.2020 durchgeführten Operationen. Weiterhin erfolgte der Vergleich von zeitlichem, strukturellem und personellem Aufwand zwischen Operationen an COVID‑19-Patienten und Non-COVID‑19-Patienten am Beispiel von vier Eingriffen: transbrachiale Embolektomie, Implantation von Hüfttotalendoprothesen (Hüft-TEP) oder Proximalem Femurnagel Antirotation (PFN-A) und Herzschrittmachern. Ergebnisse Die Schnitt-Naht-Zeiten zwischen den Eingriffen bei an COVID‑19-Erkrankten und Non-COVID-Patienten zeigten bei keinem der vier untersuchten Eingriffe signifikante Unterschiede. Die bei vielen Eingriffen als zeitaufwendig identifizierte postoperative Überwachung im Operationssaal wurde häufig durch postoperative Verlegung auf Intensivstation oder durch die Verwendung lokaler Anästhesieverfahren umgangen. Bei großen Operationen wie Hüft-TEP-Implantation war die Vorbereitungszeit signifikant verlängert. (p = 0,037). Des Weiteren zeigte sich ein signifikant höherer Bedarf an Anästhesiepflegekräften (1,5 vs. 1,0, p = 0,02). Schlussfolgerung Eine Quantifizierung des Mehraufwandes der operativen Versorgung ist durch die ohnehin komplexe Versorgung der COVID‑19-Patienten nur schwer möglich. Allerdings ist davon auszugehen, dass ein erhöhter, durch die Standarderfassung nicht dokumentierter Bedarf an zusätzlichen personellen und strukturellen Ressourcen durch die Materialzubringung von außerhalb des Operationssaales besteht.
ABSTRACT
BACKGROUND: Surgical procedures in patients suffering from coronavirus disease 2019 (COVID19) are possible under strict hygiene and protective measures and are currently carried out regularly. This study examined how much additional work this involves. MATERIAL AND METHODS: A structured evaluation of 71 surgical procedures performed at the Augsburg University Hospital between 1 November 2020 until 31 December 2020 was carried out. The operations on COVID19 patients were compared to procedures on non-COVID19 patients with respect to temporal, structural and staff resources, exemplified by four interventions: transbrachial embolectomy, total hip arthroplasty (H-TEP), proximal femoral nail antirotation (PFN-A) and new implantations of cardiac pacemakers. RESULTS: The incision to suture times between the interventions in patients with COVID19 and non-COVID19 patients did not show any significant differences in any of the four interventions evaluated. The postoperative monitoring in the operating room, which is identified as time-consuming in many interventions, was often circumvented by postoperative transfer to the intensive care unit or by the use of local anesthetic procedures. For major operations, such as HTEP, the preparation time was shown to be significantly longer (pâ¯= 0.037). Furthermore, there was a significantly higher requirement for anesthesia nursing personnel of 1.5 vs. 1.0 (pâ¯= 0.02). CONCLUSION: A quantification of the additional effort of operative treatment is difficult due to the already complex care of COVID19 patients; however, it can be assumed that there is an increased need for additional human and structural resources due to the supply of material from outside the operating room, which is not documented in the standard recording.
Subject(s)
COVID-19 , Hospitals, University , Humans , Operating Rooms , Postoperative Period , SARS-CoV-2 , Treatment OutcomeABSTRACT
BACKGROUND: The incidence of deep vein thrombosis (DVT) in CoViD-19 patients in intensive care units (ICU) has so far been investigated in only a few studies. Prospective comparative studies with non-CoViD-19 ICU patients are completely lacking. OBJECTIVE: Evaluation of the incidence of DVT in ICU patients with CoViD-19 compared to non-CoViD-19 ICU patients who were treated in the University Hospital Augsburg during the same period. In addition, the aim was to investigate what type of anticoagulation was present in CoViD-19 patients at the time the DVT occurred and to what extent DVT is associated with increased mortality in this patient population. MATERIAL AND METHODS: In this prospective single center study, which was conducted between 18 April 2020 and 30 April 2020, 20 SARS-CoV2 positive patients were compared with 20 non-CoVid-19 patients in the ICU with respect to the occurrence of DVT. For this purpose, demographic data, laboratory parameters, and clinical outcomes were recorded and evaluated. RESULTS: The rate of DVT in the investigated patient collective was markedly higher in patients with SARS-CoV2 (CoViD-19 patients 20% vs. non-CoViD-19 patients 5%). Both DVT and elevated Ddimer levels were associated with increased mortality in the present study. CONCLUSION: We recommend the determination of Ddimer levels and, in the case of elevated levels, the broad indication for compression sonography of the deep leg veins on admission of patients with suspected or confirmed SARS-CoV2. In this way DVT in the setting of CoViD-19 can be recognized early and therapeutic anticoagulation can be started. All inpatient CoViD-19 patients should receive thrombosis prophylaxis with low molecular weight heparin. Further studies on point of care methods (TEG®, ROTEM®) for the detection of hypercoagulability in SARS-CoV2 are necessary.