Continuing fast-track (Expedited) pancreaticoduodenectomy service during the COVID-19 pandemic: Experience from an established pancreatic surgical centre

Aim: Avoiding preoperative Biliary drainage (PBD) can facilitate early curative Surgery for patients with periampullary tumours. However, The evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HpB Surgery unit after achieving additional theatre sessions following prior audit. Method(s): Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021. Result(s): 64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27-357 Mmol/L). Median time (range) from diagnostic imaging to Surgery with curative intent was 21 days (3-42) for patients without PBD compared to 62 days (22-305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%, p=0.755), RO resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to Surgery (29 Vs 49 days, p=0.010) Conclusion(s): Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by COVID-19 pandemic are likely reflected in higher number of patients receiving PBD (42/71) despite clear referral pathway established following prior work at our institute.

Pediatric tonsillectomy in England 2014-2019: An analysis of administrative data

Introduction: Efficiency in health care delivery is increasingly important as health care services look to recover from the COVID-19 pandemic. Day-case elective surgery can help keep hospital beds free and reduce the risk of nosocomial infection. We aimed to investigate outcomes for day-case and overnight stay elective pediatric tonsillectomy in England. Method: Data on tonsillectomies in patients aged ≤18 years were extracted from the Hospital Episodes Statistics (HES) data set from April 1, 2014, to March 31, 2019. HES contains data for all National Health Service-funded hospital admissions in England. Data were categorized as those seen as day cases and those that involved an overnight stay. Primary outcome was readmission within 30 days of discharge. Multilevel logistic regression modeling was used to explore the relationship between tonsillectomy, day-case surgery, and 30-day readmission. Covariates included age, sex, year, indication for operation, additional procedures (eg, adenoidectomy), and surgical technique (coblation). Results: A data set of 156,942 tonsillectomy procedures across 133 hospital trusts (centers) was identified over a 5-year period. Of these procedures, 88,354 (56.3%) were daycase procedures. Patients who were seen for day-case surgery were significantly older, with 39.8% of 0- to 4-year-olds seen as a day case compared with 73.1% of 15- to 18-year-olds. Patients with hypertrophy, obstructive sleep apnea, or adenoid involvement were much less likely to have day-case surgery than those without (70.8% vs 46.6%, respectively). The lowest rates of readmission were in patients aged 5 to 7 years and patients with hypertrophy, adenoid involvement, or obstructive sleep apnea. Centers that had higher day-case rates have lower 30-day readmission for infection. Conclusion: Our study provides further evidence of the safety of day-case tonsillectomy surgery for the majority of paediatric patients.

Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation.

OBJECTIVES: Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT-anaesthetics department led tracheostomy team. METHOD: A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. RESULTS: Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13-20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23-40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7-16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. CONCLUSION: Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.