Crossing borders to change lives: Surgical mission amidst the COVID-19 pandemic.

INTRODUCTION: During the COVID pandemic, elective global surgical missions were temporarily halted for the safety of patients and travelling healthcare providers. We discuss our experience during our first surgical mission amidst the pandemic. We report a safe and successful treatment of the patients, detailing our precautionary steps and outcomes. METHODS: Retrospective manual chart review and data collection of patients' charts was conducted after IRB approval. We entail our experience and safety steps followed during screening, operating and postoperative care to minimize exposure and improve outcomes during a surgical mission in an outpatient setting during the pandemic. The surgical mission was from February 8 to February 12, 2022. RESULTS: A total of 60 patients who were screened. 33 patients underwent surgical intervention. One patient required postoperative hospitalization for a biliary duct leak. No patient or healthcare provider tested positive for COVID at the end of the mission. The average age of patients was 46.9 years. The average operative time was 116 min, and all patients had local nerve blocks. It included 45 health work providers. CONCLUSIONS: It is safe to perform outpatient international surgery during the pandemic while following pre-selected precautions.

The First COVID-19 Pandemic Wave and the Effect on Health Care Trainees: A National Survey Study.

BACKGROUND: This study observes the trends and patterns among trainees during the coronavirus disease 2019 (COVID-19) pandemic and their response to resident education and hospital/program support. METHODS: An anonymous online 31-question survey was distributed to medical students and postgraduate year residents. Topics included were demographics, clinical responsibilities, educational/curricula changes, and trainee wellness. Descriptive analysis was performed for each set of demographic groupings as well as 2 and 3 group comparisons. RESULTS: Total 1051 surveys collected, 930 used for analysis: 373 (40.1%) male, 434 (46.6%) aged 30-34 years, 588 (63.2%) white, 417 (44.8%) married, 168 (18%) with children, and 323 (34.7%) from the Northeast region. The Northeast experienced difficulty sleeping, feelings of guilt, hopelessness, and changes in appetite (P = .0077). The pandemic interfered significantly with relationships and living situations (P < .0001). Trainees 18-34 years believed the pandemic affected residency training (P < .0001). Surgical residents were concerned about reaching numbers of operative procedures to graduate (P < .0001). Residency programs adhered to ACGME work restrictions (P < .0001). CONCLUSION: We aim to provide continued educational support for our trainees' clinical development and well-being during the COVID-19 pandemic.

Coronavirus Disease 2019 and the Injured Patient: A Multicenter Review.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been shown to affect outcomes among surgical patients. We hypothesized that COVID-19 would be linked to higher mortality and longer length of stay of trauma patients regardless of the injury severity score (ISS). METHODS: We performed a retrospective analysis of trauma registries from two level 1 trauma centers (suburban and urban) from March 1, 2019, to June 30, 2019, and March 1, 2020, to June 30, 2020, comparing baseline characteristics and cumulative adverse events. Data collected included ISS, demographics, and comorbidities. The primary outcome was time from hospitalization to in-hospital death. Outcomes during the height of the first New York COVID-19 wave were also compared with the same time frame in the prior year. Kaplan-Meier method with log-rank test and Cox proportional hazard models were used to compare outcomes. RESULTS: There were 1180 trauma patients admitted during the study period from March 2020 to June 2020. Of these, 596 were never tested for COVID-19 and were excluded from the analysis. A total of 148 COVID+ patients and 436 COVID- patients composed the 2020 cohort for analysis. Compared with the 2019 cohort, the 2020 cohort was older with more associated comorbidities, more adverse events, but lower ISS. Higher rates of historical hypertension, diabetes, neurologic events, and coagulopathy were found among COVID+ patients compared with COVID- patients. D-dimer and ferritin were unreliable indicators of COVID-19 severity; however, C-reactive protein levels were higher in COVID+ relative to COVID- patients. Patients who were COVID+ had a lower median ISS compared with COVID- patients, and COVID+ patients had higher rates of mortality and longer length of stay. CONCLUSIONS: COVID+ trauma patients admitted to our two level 1 trauma centers had increased morbidity and mortality compared with admitted COVID- trauma patients despite age and lower ISS. C-reactive protein may play a role in monitoring COVID-19 activity in trauma patients. A better understanding of the physiological impact of COVID-19 on injured patients warrants further investigation.

Outcomes of SARS-CoV-2 infection in patients with celiac disease: a multicenter research network study.

Background: Celiac disease (CD) is associated with an increased risk for respiratory infections and severe outcomes. No data have been reported in the scientific literature regarding the outcomes of COVID-19 in this population. The aim of this study was to report matched clinical outcomes in a large cohort of 930 patients with COVID-19 in the setting of known CD. Methods: Analysis of a multicenter research network TriNETX was performed, including COVID-19 patients aged more than 16 years. Outcomes of COVID-19-positive patients with concurrent CD were compared with a propensity-matched cohort of patients without CD. Results: A total of 341,499 patients with SARS-CoV-2 infection were identified on the research network: 930 (0.27%) with CD and 340,569 (99.73%) without CD. In the 30- and 60-day periods post SARS-CoV-2 infection, 12 (1.29%) and 13 (1.40%) deaths, respectively, were reported in the CD group. Fewer patients in the CD group reached the composite outcome of either mechanical ventilation or mortality at 60 days (risk ratio 0.58, 95% confidence interval 0.36-0.95). After propensity matching, no difference in clinical outcomes was observed. Conclusion: Our data suggest that patients with CD are not at increased risk of COVID-19-related morbidity or mortality.

Prior Bariatric Surgery is Associated with a Reduced Risk of Poor Outcomes in COVID-19: Propensity Matched Analysis of a Large Multi-institutional Research Network.

PURPOSE: Through sustained weight loss and improvement in metabolic co-morbidities, bariatric surgery is hypothesized to reduce the risk of severe COVID-19. Small studies have suggested favorable outcomes; however, large population-based studies are lacking. MATERIALS AND METHODS: We conducted a retrospective cohort study utilizing the multi-institutional research network TriNeTx platform. Participants diagnosed with COVID-19 were identified and divided into cohorts based on prior bariatric surgery (BS). Primary study outcome was a composite event of death or requirement for mechanical ventilation up to 30-day following the diagnosis of COVID-19. Other outcomes included death, hospitalization, critical care need, and acute kidney injury in the 30-day follow-up period. Outcomes were compared in BS and non-BS cohorts after propensity score matching. RESULTS: There were significant differences in patient demographics and co-morbidities between the BS and non-BS groups. In the propensity score-matched analysis, there was a lower risk of reaching the primary endpoint of mechanical ventilation or mortality at 30 days after COVID-19 diagnosis in the BS cohort compared to the non-BS cohort (risk ratio (RR) 0.40, 95% CI 0.25-0.65). Mortality rate was lower in the BS cohort (RR 0.42, 95% CI 0.22-0.80), and patients in the BS group were less likely to require critical care (RR 0.54, 95% CI 0.38-0.77), mechanical ventilation (RR 0.43, 95% CI 0.24-0.78) or develop acute kidney injury (RR 0.57, 95% CI 0.43-0.76) after COVID-19 diagnosis. CONCLUSION: Prior bariatric surgery is associated with a reduced risk of poor outcomes of COVID-19. Furthermore, large prospective studies are needed.

Patients with idiopathic pulmonary fibrosis have poor clinical outcomes with COVID-19 disease: a propensity matched multicentre research network analysis.

INTRODUCTION: Outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with pre-existing idiopathic pulmonary fibrosis (IPF) remain understudied, and it is unknown if IPF is an independent predictor of worse disease course. Herein, we report the clinical outcomes in a large cohort of 251 patients with COVID-19 in the setting of known IPF. Outcomes were compared with a propensity matched cohort of patients with COVID-19 without IPF. METHODS: Analysis of a federated multicentre research network TriNetX was performed including patients more than 16 years of age diagnosed with SARS-CoV-2 infection. Outcomes in patients diagnosed as positive for SARS-CoV-2 infection with concurrent IPF were compared with a propensity matched cohort of patients without IPF. RESULTS: A total of 311 060 patients with SARS-CoV-2 infection on the research network were identified, 251 patients (0.08%) carried a diagnosis of IPF. Mean age of patients with IPF was 68.30±12.20 years, with male predominance (n=143, 56.97%). Comorbidities including chronic lower respiratory diseases, diabetes mellitus, ischaemic heart disease and chronic kidney disease were more common in patients with IPF when compared with the non-IPF cohort. After propensity matching, higher rates of composite primary outcome (death or mechanical ventilation) at 30 and 60 days, as well as need for hospitalisation, critical care, and acute kidney injury were observed in the IPF cohort. CONCLUSION: Poor outcomes of COVID-19 disease were observed in patients with IPF after robust matching of confounders. Our data confirm that patients with IPF constitute a high-risk cohort for poor outcomes related to COVID-19 disease.

Cardiac tamponade in COVID-19 patients: Management and outcomes.

IMPORTANCE: Cardiac tamponade requiring emergent intervention is a possible complication of coronavirus disease 2019 (COVID-19) infection. Favorable clinical outcomes are possible if timely management and drainage are performed unless ventricular failure develops. OBSERVATION: Cardiac tamponade in COVID-19, based on the limited reported cases, seems to be more common among middle-aged men with observed complications in black and ethnic minorities. Prognosis is worse amongst patients with concomitant ventricular failure. DESIGN AND METHODS: This is a case series of three COVID-19 patients complicated by cardiac tamponade, requiring surgical intervention at a single institution in New York. INTERVENTION: Pericardial window, Pericardiocentesis. OUTCOME: One patient had recurrence of cardiac tamponade with hemorrhagic component but fully recovered and was discharged home. Two patients developed cardiac tamponade with concomitant biventricular failure, resulting in death. CONCLUSION AND RELEVANCE: Cardiac tamponade with possible concomitant biventricular failure can develop in COVID-19 patients; incidence seems to be highest at the point of marked inflammatory response. Concomitant ventricular failure seems to be a predictor of poor prognosis.