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World J Surg ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2229013


BACKGROUND: A debate remains on how long to postpone surgery after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to determine surgical outcomes at different time points after a positive SARS-CoV-2 test. METHODS: This cohort study included non-preoperative critically ill adult surgical patients from 5/2020-5/2021 and a subset of SARS-CoV-2 positive patients 15-30 days before surgery from 5/2020-12/2021. Demographics, comorbidities, surgical variables, and outcomes were compared between SARS-CoV-2 positive patients within 50 days before surgery to SARS-CoV-2 negative surgical patients. Cases were stratified based on the timing of SARS-CoV-2 positivity before surgery in days (< 15, 15-30, > 30). Outcomes were compared between strata and against SARS-CoV-2 negative controls. A multivariable model was built to determine the association that the timing of SARS-CoV-2 positivity has on the odds of a major complication. RESULTS: The SARS-CoV-2 positive cohort had 262 patients compared to 1,840 SARS-CoV-2 negative patients. Timing strata contained 145 (< 15 days), 53 (15-30 days), and 64 (> 30 days). The SARS-CoV-2 positive group had a higher incidence of comorbidities (87.4% vs. 57.2%) and underwent more emergent surgery (45.7% vs. 9.3%). The odds of major complications in patients positive for SARS-CoV-2 before surgery were 1.88 (1.13-3.15) (< 15 days), 0.43 (0.14-1.30) (15-30 days), and 0.98 (0.44-2.21) (31-50 days) times the odds in SARS-CoV-2 negative surgery patients when controlling for other variables. CONCLUSION: Timing of SARS-CoV-2 positivity before surgery has an impact on major complications. In certain cases, it may be appropriate to postpone surgery 14 days after SARS-CoV-2 positivity.

J Burn Care Res ; 42(6): 1103-1109, 2021 11 24.
Article in English | MEDLINE | ID: covidwho-1276188


The impact of the coronavirus disease 2019 (COVID-19) pandemic on admission patterns and outcomes at a burn center is still largely unknown. The aim of this study was to determine how the COVID-19 pandemic affected the epidemiology of burn admissions at a major metropolitan burn center. This retrospective cohort study examined how the COVID-19 pandemic affected burn volumes and time to presentation. All burn admissions were included from January 20 to August 31 for the years 2020, 2019, and 2018. The COVID-19 pandemic group included admissions from January 20, 2020 to August 31, 2020 and was compared to the nonpandemic group comprised of admissions from January 20 to August 31 in 2018 and 2019. Subgroup analysis was performed according to meaningful dates during the COVID-19 pandemic including the first U.S. COVID-19 case, shelter-in-place, and state reopening orders. Admission volumes were 403 patients in the COVID-19 pandemic group compared to a mean of 429 patients in the nonpandemic group, which correlated to a 5.8% decrease in volume during the pandemic. The pandemic group showed an increase in time to presentation of 1 day (P < .0001). Subgroup analysis demonstrated stable admission volumes and an increase in time to presentation of 1 day (P < .0001) at each time point. During shelter-in-place orders, there were higher rates of second/third-degree burns and operative burns (94.7 vs 56.3% and 45.6 vs 27%, P < .0001, P = .013). During the pandemic, there were stable admission volumes, delayed time to admission, and an increase in operative burns during shelter-in-place orders. This reinforces the need to maintain appropriate burn center staffing and resources during the COVID-19 pandemic.

Burns/epidemiology , Burns/therapy , COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Patient Admission/statistics & numerical data , Burn Units , COVID-19/therapy , Female , Humans , Male , Retrospective Studies , United States
Journal of Burn Care & Research ; 42:S56-S56, 2021.
Article in English | CINAHL | ID: covidwho-1174923


Introduction The current and long-term impact of the coronavirus disease 2019 (COVID-19) global pandemic on our healthcare system is still unknown. When healthcare resources were being diverted to only the most critical of needs, emergent surgical and burn care remained essential. Currently, no data exist on the impact of a global pandemic on a burn center. Our aim for this study was to understand how the COVID-19 pandemic affected admissions, hospital course, and discharges at a major metropolitan burn center. Methods This was a retrospective cohort study of admissions to our burn center. Our institution's medical record was reviewed from 1/1–8/31 for years 2020, 2019, & 2018. We included all thermal, chemical, and electrical burn inpatient admissions over these time periods. Non-burn wound admissions and vulnerable patient populations were excluded. Our population included 1,358 patients. These patients were grouped by year 2020 (n=425), 2019 (n=470), and 2018 (n=463). The medical record was queried for admission, hospital course, and discharge variables. SAS 9.4 statistical software was used to compare the pre-pandemic 2018/2019 groups against the 2020 group. Group means were compared using two-sample two-tailed t-tests, and categorical variables were compared using Chi-Square analysis. Results In 2020 the burn center had 425 admissions compared to 470 and 463 in 2019 and 2018 respectively. On admission, there were no differences in age, gender, pediatric admissions, burn etiology, total body surface area (TBSA), TBSA >20%, work-related injuries, or suspected abuse related injuries. Of note, the mean days from injury to admission for the groups were (2020 2.5±4.9 vs 2019 1.4±4.3, p=0.001, vs 2018 1.5±4.3, p=0.0017). Groups were similar in respect to burns requiring surgery and mean OR visits. 2019 and 2018 had increased ICU admissions compared to the 2020 cohort (ICU: 2020 60-(14%) vs 2019 91-(19.4%), p=0.041, vs 2018 108-(23.3%), p=0.033). Inpatient mortality was lower in the 2020 cohort compared to the pre-pandemic cohorts (2020 2 (0.6%) vs 2019 9 (2.5%), p=0.04, vs 2018 14 (4.2%) p=0.0017). Conclusions Volume at our burn center remains high during the pandemic. There is an increased lag time from burn injury to hospital admission in the 2020 cohort. We hypothesize this is due to patients' avoiding the hospital due to fear of contracting COVID-19. TBSA is similar across groups, but ICU admissions are down in the 2020 cohort. Further work is needed to understand whether the increased lag time has affected outcomes and whether the decreased ICU admissions are due to yearly variation or the pandemic.