ABSTRACT
The hypercoagulable state of COVID-19 infection presents a challenge to microsurgeons. While the American Society of Anesthesiologists recommends deferring surgery for 4–10 weeks for COVID-19-infected patients, little else is known regarding how to mitigate thrombotic complications for patients undergoing free tissue transfer. Here, we present a presumed COVID-19-induced hypercoagulable state in a patient undergoing abdominally based free tissue transfer for breast reconstruction as a brief review of the literature to guide clinical decision making. © 2023 The Author(s).
ABSTRACT
BACKGROUND CONTEXT: The coronavirus-19 (COVID-19) pandemic has altered the standard of care for spine surgery in many ways. However, there is a lack of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic. In particular, no large database study evaluating the impact of the COVID-19 pandemic on spine surgery outcomes has been published. PURPOSE: To evaluate the impact of the COVID-19 pandemic on perioperative factors and postoperative outcomes of lumbar fusion procedures. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients who underwent primary, elective lumbar fusionbetween 2019 and 2020. OUTCOME MEASURES: Thirty-day readmission, reoperation, morbidity, complications, operative time, non-home discharge disposition, length of hospital stay, total RVUs and RVUs per minute. METHOD(S): The ACS-NSQIP database was queried for all patients who underwent primary lumbar fusion in 2019 and 2020. Exclusion criteria included cervical or thoracic fusion, arthroplasty, non-elective, emergency cases, deformity procedures, malignancy, preoperative sepsis, wound infection and missing perioperative variables. Patients were grouped into cohorts based on 2019 or 2020 operation year. Multivariate logistic and Poisson regression models were utilized to evaluate the impact of 2020 operative year on postoperative outcomes. RESULT(S): A total of 27,446 patients were included in the analysis (12,473 cases in 2020). For the 2020 cohort, non-white race (24.9% vs 23.4%, p=0.004), functional dependence (1.8% vs 1.4%, p=0.022), congestive heart failure (0.5% vs 0.3%, p=0.015), and ASA class =3 (53.5% vs 52.2%, p=0.037) were more common. Lumbar fusions performed in 2020 were also associated with longer mean operative time (209.3+/-99.3 vs. 205.9+/-98.6 minutes, p=0.005) and higher mean fusion levels (1.45+/-0.69 vs 1.41+/-0.65, p 0.05). However, operation year 2020 independently predicted morbidity (OR 1.087 [95% CI 1.007-1.172], p=0.032), pneumonia (1.407 [1.039-1.906], p=0.027), DVT (1.508 [1.106-2.056], p=0.009) and sepsis (1.537 [1.101-2.146], p=0.012). In terms of perioperative variables, operation year 2020 predicted greater operative time (1.012 [1.001-1.013], p=0.046), non-home discharge (0.690 [0.642-0.743], p<0.001), and total RVUs (1.044 [1.004-1.083], p=0.033). CONCLUSION(S): Lumbar fusion procedures performed amidst the COVID-19 pandemic were associated with poorer outcomes, including higher rates of morbidity, pneumonia, DVT and sepsis. In addition, surgeries performed in 2020 were associated with longer operative times and less frequent non-home discharge disposition. FDA DEVICE/DRUG STATUS: This does not discuss or include any applicable devices or drugs. Copyright © 2022
ABSTRACT
The chapter addresses a comprehensive review of the Internet of Drone Technology (IoDT) and its advancements in different spheres of our daily life with special focus on smart cities. To be more specific, this chapter explores Internet usage in drone technology corresponding to the scenario of intelligent cities. There has also been discussion about the use of IoDT in unmanned vehicles. The chapter also addresses IoDT concerns related to security and communication. Additional IoDT implementations have been addressed in various agricultural usages. It also discusses the usage of IoT-based drone technology to fight against flood and fire outbreaks, and highlights some future changes that can be explored in this field. Some of the new fields that can be enhanced by IoT-backed drone technology are unique applications like traffic management, control of unmanned vehicles, assistance in emergency corridors, intelligent production as well as agricultural development, disaster management, and, last but not least, the management of COVID outbreak. © 2022 selection and editorial matter, Arun Kumar Rana, Nitin Goyal, Sharad Sharma, Suman Lata Tripathi.