Effects of COVID-19 Outbreak on Emergency Surgeries for Occlusive Colorectal Cancers

Coronavirus-19 (COVID-19) is caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Since the CoV-19 outbreak, public health has been affected in several areas, especially, mortality from malignancies has increased. Colorectal cancers (CRCs) is the third-most common cause of cancer-related deaths across the world. The present study aimed to investigate the time of CRC patients' admission to hospital and its effects in the light of COVID-19 outbreak. We examined the case of 62 patients who visited our hospital emergency department with intestinal obstruction due to CRC between 2019 and 2020. We categorised the patients admitted during the COVID-19 pandemic as group 1 and the others as group 2. We comparatively evaluated the demographic data, complaints and duration, tumour characteristics, blood values, complications, mortality rates and the length of hospital stay of the patients. We noted that the duration of admission to the hospital was prolonged after the patients developed obstructive symptoms. As incidences of nausea/vomiting became more frequent, the duration of admission to the hospital after the complaints began and the resultant mortality rate were statistically higher among the group 1 patients. The haematocrit (htc) value was lower and the tumour size was larger in the deceased patients. COVID-19 pandemic delayed the diagnosis of patients with colorectal cancer. The time that elapsed after occlusion in CRC increased the rate of mortality and morbidity. It was observed that, especially, mortality was higher for elderly patients with low htc values. This increase in the mortality rates suggests the importance of the time of admission to the hospital in case of obstructive CRC. We thus believe that it is essential to propagate that the hospitals are safe from covid to encourage the public to avail hospital services for serious cases in order to ensure timely diagnosis and treatment. Koronavirüs-19 (COVID-19), şiddetli akut solunum sendromu-koronavirüs 2'den (SARS-CoV-2) kaynaklanır. COVID-19 salgını sırasıda, çeşitli alanlarda halk sağlığı etkilenmiş, özellikle malignitelerden ölüm oranları artmıştır. Kolorektal kanserler (CRC), dünya çapında kansere bağlı ölümlerin üçüncü en yaygın nedenidir. Bu çalışma, CRC hastalarının hastaneye yatış sürelerini ve etkilerini COVID-19 salgını etkisinde incelemeyi amaçlamaktadır. 2019-2020 yılları arasında CRC'ye bağlı bağırsak tıkanıklığı nedeniyle hastanemiz acil servisimize gelen 62 hastayı inceledik. COVID-19 salgını sırasında başvuran hastaları grup 1 ve diğerlerini grup 2 olarak kategorize ettik. Hastaların demografik verilerini, şikayet ve süresini, tümör özelliklerini, kan değerlerini, komplikasyonlarını, ölüm oranlarını ve hastanede kalış sürelerini karşılaştırdık. Hastalarda obstrüktif semptomlar geliştikten sonra hastaneye başvuru süresinin uzadığını belirledik. Bulantı/kusma sıklığı arttıkça, şikayetler başladıktan sonra hastaneye başvuru süresi ve sonuçta ortaya çıkan ölüm oranı grup 1 hastalarında istatistiksel olarak daha yüksek bulundu. Ölen hastalarda hematokrit (Htc) değeri daha düşüktü ve tümör boyutu daha büyüktü. COVID-19 salgını, kolorektal kanserli hastaların teşhisini geciktirdi. CRC'de oklüzyondan sonra geçen süre mortalite ve morbidite oranını artırdı. Özellikle Htc değeri düşük yaşlı hastalarda mortalitenin daha yüksek olduğu görüldü. Ölüm oranlarındaki bu artış, obstrüktif CRC durumunda hastaneye yatış süresinin önemini ortaya koymaktadır. Bu nedenle, zamanında tanı ve tedaviyi sağlamak için halkı ciddi olgularda hastane hizmetlerinden yararlanmaya teşvik etmenin gerekli olduğuna inanıyoruz.

Association between Acute Pancreatitis and COVID-19: Could Pancreatitis Be the Missing Piece of the Puzzle about Increased Mortality Rates?

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 commenced in Wuhan China in 2019 and soon spread worldwide. SARS-CoV-2 enters the cell by binding to the ACE II receptor and begins viral replication. The effects and clinical findings of SARS-CoV-2 on the liver, kidney, heart, gastrointestinal (GI) system and especially lungs have been widely discussed. However, the effects on the pancreas-another organ that also expresses ACE II-have not been studied. METHODS: This work prospectively evaluated data from 316 patients who were admitted with a diagnosis of COVID-19 pneumonia. The patients were categorized into three according to the severity of pneumonia (mild, severe, critical). Demographic data, rate of pancreatitis, biochemical parameters, and radiological images from each group were analyzed. The patients were divided into two groups and outcomes were compared: COVID-19 patients with acute pancreatitis (Group P) and without acute pancreatitis (Group C). RESULTS: The median age was 54 (18-87), and the median age for patients with acute pancreatitis was 55 (26-84). As an expected finding, we found a positive correlation between advanced age and mortality (p = 0.0003). 12.6% of the patients had acute pancreatitis. While pancreatitis was not seen in patients on mild status, the rate of pancreatitis was 32.5% in critical patients. Hospitalization and mortality rates were higher in patients with COVID-19 accompanied by acute pancreatitis (p = 0.0038 and p < 0.0001, respectively). C-Reactive Protein (CRP) and ferritin were significantly higher in those who had pancreatitis (p < 0.0001). D-Dimer and procalcitonin levels had only a small difference (p = 0.1127 and p = 0.3403, respectively). CONCLUSION: Acute pancreatitis alone is a clinical condition that can lead to mortality and may be one of the reasons for the exaggerated immune response developing in the progression of COVID-19. Our results point out that the presence of pancreatic damage triggered by SARS-CoV-2 can deteriorate the clinical condition of patients and the mortality rate may increase in these patients.

Effects of COVID-19 pandemic on general surgical emergencies: are some emergencies really urgent? Level 1 trauma center experience.

PURPOSE: The aim of this paper is to investigate the effect of COVID-19 pandemic on general surgical emergencies as well as analyzing the effectiveness of measures taken in reducing the incidence of COVID-19 in patients and healthcare professionals. METHODS: Patients who underwent emergency surgery between the pandemic period of March 14th to May 15th 2020 and within the same period from the previous year were reviewed retrospectively. COVID-19 incidence in patients and health professionals working in the general surgery department during these periods was questioned. RESULTS: Demographic data were similar between the two time periods. The number of patients who underwent surgery in the pandemic group (n = 103) was lower than the control group (n = 252). There was a 59.1% reduction in emergency surgeries. The biggest decreases were the admissions of incarcerated hernia, uncomplicated appendicitis and acute cholecystitis (92%, 81.3%, 47.3%, respectively). During the pandemic, an increase was of patient rates who underwent surgery for complicated appendicitis and AMIO (p = 0.001, p = 0.019, respectively). The rate of mortality was higher in patients who underwent emergency surgery during pandemic (p = 0.049). The results of COVID-19 screening were positive in 6 (6/103, 5.82%) patients undergoing emergency surgery. None of the doctors working in the ward were infected with COVID-19 infection (0/20). The screening tests were positive in only two nurses working on the ward (2/24, 8.33%). CONCLUSION: In this and similar pandemics, we suggest that a new algorithm is necessary to approach emergencies and the results of this study can contribute to that end.