ABSTRACT
Introduction: The National Consultant Information Programme (NCIP) aims to support National Health Service (NHS) consultants in England with learning and continuous self-development via an online portal which compares their individual and patient outcomes against local and national benchmarks. The aim of this study is to confirm the idea that the COVID-19 pandemic has changed surgical practice for Ulcerative Colitis (UC) patients. Method(s): Hospital Episode Statistics data was extracted from NCIP using the International Classification of Diseases-10 code K51 (ulcerative colitis) and cross referencing them with procedures performed for UC. The financial year (April-March) was chosen as it corresponded to the start of the pandemic. Result(s): The table highlights a stepwise decrease in colectomies for UC during the pandemic. Proportionally the number of emergency colectomies was higher during the pandemic in 2020-21 when compared to pre-pandemic levels in 2018-2020 (p = 0.01). A simultaneous decrease was illustrated in the proportion of elective colectomies. Conclusion(s): This large national healthcare data set has provided evidence that the pandemic has had a profound impact on surgery for UC. The proportion of cases performed electively decreased, with a corresponding rise in emergency procedures. An overall decrease in operations for UC as a whole was seen;raising the concern that patients may be waiting excessively long for their surgery.
ABSTRACT
Purpose SNS is a centralised service. Centralisation can be inconvenient for patients, requiring multiple journeys, travel costs and time off work/childcare. Remote follow-up, as seen during the COVID pandemic, is beneficial for such services delivered over large geographical areas requiring multiple post-op reviews. We compared a group of patients undergoing SNS prior to the pandemic with a group in 2020 to assess the impact of remote follow-up. Method A prospectively maintained database identified consecutive patients undergoing SNS in a single centre in 2017 and compared a similar group of patients undergoing SNS in 2020. Data collected included;number of post-operative clinic appointments and distance travelled to hospital in the first 6 months post-operative period. All patients undergoing SNS in 2020 were invited to take part in a patient satisfaction survey investigating remote follow-up. Results The 2017 group (n = 7), had a total of 20 post-op clinic appointments in the 6 months following surgery (mean 2.9 appointments per patient), with 1.5 days each taken off work or requiring childcare. Patients travelled a mean total of 66 miles for appointments over 6 months. The 2020 group (n = 7) had a total of 6 post-op clinic appointments with the rest provided remotely by telephone. Each travelled a total of 14.65 miles over 6 months. From the survey, 82.4% patients were happy with telephone follow- up, 2% preferred telephone over face-to- face consultation, 13.7% preferred face-to- face appointments and 2% had no opinion. Conclusion SNS follow-up can be provided remotely with significant logistical benefits to the patients, at no detriment to their satisfaction.
ABSTRACT
Background Preferred treatment for most patients with newly diagnosed colorectal cancer and liver metastasis is LCCRT, followed by 2 stage or, less commonly, synchronous resection. Under the shadow of the first wave of COVID in the UK, with the associated surgical guidance, more synchronous resections were carried out. Aim Describe changes in surgical strategy in managing patients with CR cancer and resectable liver metastasis during the initial wave of the COVID 19 pandemic. Methods Retrospective case notes analysis of all patients diagnosed with resectable colorectal primary and liver metastases during the first 6 months of 2020 at a single centre. Outcomes at post-operative MDT were also reviewed. Results Six (mean age 61.8 years, M:F ratio 2:1, all ECOG 0) patients underwent synchronous resection between April and June. Four (66.6%) of these still had neo adjuvant systemic therapy (received before pandemic outbreak). The remaining Two proceeded straight to SR, with both receiving MDT recommendation for adjuvant chemotherapy. Three patients experienced R1 resection and went on to further chemotherapy/resection, two further went on for discussion of adjuvant chemotherapy, and one remained on intensive surveillance. Conclusions Synchronous resection could provide acceptable outcomes for patients and reduce their COVID risk exposure in the short term. The balance between managing surgically resectable cancers in a timely fashion and the risks of morbidity and mortality in the wake of the COVID-19 pandemic becomes more critical as time progresses. Further observation of the changes in management driven by this pandemic, and the resulting outcomes are warranted.