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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-320808

ABSTRACT

Background: To determine on a national basis the surgical activity regarding appendectomies during the first Italian wave of the COVID-19 pandemic. Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. Methods: Multicenter, observational study investigating the outcomes of patients undergoing appendectomy in the two months of March-April 2019 vs. March-April 2020. The primary outcome was the number of appendectomies performed during each of the two months, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs. open), and the complication rates. Results: 1541 patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the study inclusion criteria. 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.8%) in 2019. Patients with complicated appendicitis operated in 2019 were 76 (9.6%) vs. 87 (15.9%) in 2020 (p = 0.001). An increase in the number of post-operative complications was found in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), having a unit AAST (+ 26%) increase, having waited for surgery > 24 h (+ 58%), being the surgeon aged > 40 years (+ 47%), undergoing open surgery (+ 112%) and being converted to open surgery (+ 166%). Conclusions: In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. Patients undergoing surgery during the first pandemic wave were more frequently affected by more severe appendicitis than the previous year's timeframe and a higher complication rate was reported. Trial registration : ResearchRegistry ID 5789.

2.
J Clin Med ; 10(19)2021 Sep 30.
Article in English | MEDLINE | ID: covidwho-1444247

ABSTRACT

Herein, we performed a meta-analysis of published clinical outcomes of corona virus disease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between December 1, 2019 and April 20, 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), cough (65%), dyspnea (48%), and gastrointestinal symptoms (28%) were predominant on hospital admission. The most common comorbidities were hypertension (83%), diabetes mellitus (34%), and cardiac disease (23%). The pooled prevalence of acute respiratory distress syndrome and acute kidney injury were 58% and 48%, respectively. Invasive ventilation and dialysis were required in 24% and 22% patients, respectively. In-hospital mortality rate was as high as 21%, and increased to over 50% for patients in intensive care unit (ICU) or requiring invasive ventilation. Risk of mortality in patients with acute respiratory distress syndrome (ARDS), on mechanical ventilation, and ICU admission was increased: OR = 19.59, OR = 3.80, and OR = 13.39, respectively. Mortality risk in the elderly was OR = 3.90; however, no such association was observed in terms of time since transplantation and gender. Fever, cough, dyspnea, and gastrointestinal symptoms were common on admission for COVID-19 in kidney transplant patients. Mortality was as high as 20% and increased to over 50% in patients in ICU and required invasive ventilation.

3.
Updates Surg ; 73(6): 2205-2213, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1293469

ABSTRACT

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020.


Subject(s)
Appendicitis , COVID-19 , Laparoscopy , Appendectomy , Appendicitis/epidemiology , Appendicitis/surgery , Cohort Studies , Humans , Italy/epidemiology , Length of Stay , Pandemics , Postoperative Complications/epidemiology , Retrospective Studies , SARS-CoV-2
5.
Updates Surg ; 73(2): 731-744, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1114327

ABSTRACT

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020). RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.


Subject(s)
COVID-19/epidemiology , Elective Surgical Procedures/statistics & numerical data , Infection Control/standards , Laparoscopy/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
6.
Updates Surg ; 73(2): 745-752, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1002181

ABSTRACT

Since the beginning of the pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 (COVID-19), several articles reported negative outcomes in surgery of infected patients. Aim of this study is to report results of patients with COVID-19-positive swab, in the perioperative period after surgery. Data of COVID-19-positive patients undergoing emergent or oncological surgery, were collected in a retrospective, multicenter study, which involved 20 Italian institutions. Collected parameters were age, sex, body mass index, COVID-19-related symptoms, patients' comorbidities, surgical procedure, personal protection equipment (PPE) used in operating rooms, rate of postoperative infection among healthcare staff and complications, within 30-postoperative days. 68 patients, who underwent surgery, resulted COVID-19-positive in the perioperative period. Symptomatic patients were 63 (92.5%). Fever was the main symptom in 36 (52.9%) patients, followed by dyspnoea (26.5%) and cough (13.2%). We recorded 22 (32%) intensive care unit admissions, 23 (33.8%) postoperative pulmonary complications and 15 (22%) acute respiratory distress syndromes. As regards the ten postoperative deaths (14.7%), 6 cases were related to surgical complications. One surgeon, one scrub nurse and two circulating nurses were infected after surgery due to the lack of specific PPE. We reported less surgery-related pulmonary complications and mortality in Sars-CoV-2-infected patients, than in literature. Emergent and oncological surgery should not be postponed, but it is mandatory to use full PPE, and to adopt preoperative screenings and strategies that mitigate the detrimental effect of pulmonary complications, mostly responsible for mortality.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Elective Surgical Procedures/mortality , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Postoperative Complications/mortality , Adult , Aged , Aged, 80 and over , COVID-19/transmission , Emergencies , Female , Humans , Infection Control/organization & administration , Italy/epidemiology , Male , Middle Aged , Occupational Exposure/statistics & numerical data , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Retrospective Studies , Risk Factors , SARS-CoV-2
8.
World J Emerg Surg ; 15(1): 38, 2020 06 08.
Article in English | MEDLINE | ID: covidwho-574739

ABSTRACT

Following the spread of the infection from the new SARS-CoV2 coronavirus in March 2020, several surgical societies have released their recommendations to manage the implications of the COVID-19 pandemic for the daily clinical practice. The recommendations on emergency surgery have fueled a debate among surgeons on an international level.We maintain that laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis, even in the COVID-19 era. Moreover, since laparoscopic cholecystectomy is not more likely to spread the COVID-19 infection than open cholecystectomy, it must be organized in such a way as to be carried out safely even in the present situation, to guarantee the patient with the best outcomes that minimally invasive surgery has shown to have.


Subject(s)
Cholecystectomy/standards , Cholecystitis, Acute/surgery , Coronavirus Infections/complications , Infection Control/standards , Pneumonia, Viral/complications , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Cholecystectomy/methods , Cholecystitis, Acute/virology , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Societies, Medical
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