Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature.

The authors conducted a systematic review on the effect of coronavirus disease 2019 on electrophysiology (EP) practice and procedure volume in various settings. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Embase were examined with combinations of medical subject headings terms for identification of the relevant studies. After excluding duplicates, irrelevant, and ineligible studies, 23 studies were included for full qualitative analysis. The overall study-level volume reduction of EP procedures ranged from 8 to 96.7%. All studies reported an overall reduction in EP physiology procedures being carried out except one in Poland, which reported an overall increase in the total EP procedures carried out in 2020. This study still reported a decrease in EP procedure volume during the first lockdown phase. Procedural volume reduction was seen most commonly for cardiovascular implantable electronic device placement (20/23 studies, 86.9%), electrophysiology studies (11/23 studies, 47.8%), and ablations (9/23, 39.1% studies). The most common reason stated for the observed decline in EP procedures was the cancellation and postponement of nonurgent elective cases in the hospitals (15/23 studies, 65.2%). There has been an overall reduction in EP procedure volume across different centers. The impact of the decline in EP procedures will be seen only after the services resume to prepandemic levels, but an increase in-patient volume and procedure waiting time is expected. This review will provide insights into improving healthcare service delivery in times of unprecedented public health emergencies.

COVID-19 and the forgone health benefits of elective operations.

BACKGROUND AND AIM: The first SARS-CoV-2 pandemic wave in Germany involved a tradeoff between saving the lives of COVID-19 patients by providing sufficient intensive care unit (ICU) capacity and foregoing the health benefits of elective procedures. This study aims to quantify this tradeoff. METHODS: The analysis is conducted at both the individual and population levels. The analysis calculates quality-adjusted life years (QALYs) to facilitate a comparison between the health gains from saving the lives of COVID-19 patients in the ICU and the health losses associated with postponing operative procedures. The QALYs gained from saving the lives of COVID-19 patients are calculated based on both the real-world ICU admissions and deaths averted from flattening the first wave. Scenario analysis was used to account for variation in input factors. RESULTS: At the individual level, the resource-adjusted QALY gain of saving one COVID-19 life is predicted to be 3 to 15 times larger than the QALY loss of deferring one operation (the average multiplier is 9). The real-world QALY gain at the population level is estimated to fall within the range of the QALY loss due to delayed procedures. The modeled QALY gain by flattening the first wave is 3 to 31 times larger than the QALY loss due to delayed procedures (the average multiplier is 17). CONCLUSION: During the first wave of the pandemic, the resource-adjusted health gain from treating one COVID-19 patient in the ICU was found to be much larger than the health loss from deferring one operation. At the population level, flattening the first wave led to a much larger health gain than the health loss from delaying operative procedures.

The impact of the coronavirus disease 2019 pandemic on elective urological procedures in Australia.

OBJECTIVE: To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic. METHODS: Data were extracted from publicly available datasets from Medicare Benefits Schedule using item numbers assigned to each commonly performed urological intervention. These procedures were divided into three groups: Oncological therapeutic, diagnostic, and non-oncological therapeutic procedures. A smoothing model, based on the historic procedure numbers from 2017 to 2019, was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020. These forecasted models were compared with reported figures. RESULTS: A total of 108 169 procedures were performed between January 2020 and June 2020 based on the Medicare Benefits Schedule item numbers listed. There was a significant reduction (percentage change) in total procedures performed in April 2020 (-22.6%, 95% confidence interval [CI]: -28.7% to -15.4%) and May 2020 (-33.2%, 95% CI: -37.5% to -28.3%). There was a significant reduction in oncological therapeutic, non-oncological therapeutic, and diagnostic procedures performed in April 2020 and May 2020 (p<0.05). These numbers did not include procedures performed in public sector. CONCLUSION: There was a significant reduction in total urological procedures (including diagnostic, oncological, and non-oncological) performed in months of April 2020 and May 2020 during time of federal restrictions. Both public and private healthcare sectors need to be supported in the upcoming months to prevent further delays in treatment and poorer clinical outcomes.

Implementation of an enhanced recovery protocol at a safety net hospital : a silver lining to COVID-19?

AIMS: This study aimed to evaluate whether an enhanced recovery protocol (ERP) for arthroplasty established during the COVID-19 pandemic at a safety net hospital can be associated with a decrease in hospital length of stay (LOS) and an increase in same-day discharges (SDDs) without increasing acute adverse events. METHODS: A retrospective review of 124 consecutive primary arthroplasty procedures performed after resuming elective procedures on 11 May 2020 were compared to the previous 124 consecutive patients treated prior to 17 March 2020, at a single urban safety net hospital. Revision arthroplasty and patients with < 90-day follow-up were excluded. The primary outcome measures were hospital LOS and the number of SDDs. Secondary outcome measures included 90-day complications, 90-day readmissions, and 30day emergency department (ED) visits. RESULTS: The mean LOS was significantly reduced from 2.02 days (SD 0.80) in the pre-COVID cohort to 1.03 days (SD 0.65) in the post-COVID cohort (p < 0.001). No patients in the pre-COVID group were discharged on the day of surgery compared to 60 patients (48.4%) in the post-COVID group (p < 0.001). There were no significant differences in 90-day complications (13.7% (n = 17) vs 9.7% (n = 12); p = 0.429), 30-day ED visits (1.6% (n = 2) vs 3.2% (n = 4); p = 0.683), or 90-day readmissions (2.4% (n = 3) vs 1.6% (n = 2); p = 1.000) between the pre-COVID and post-COVID groups, respectively. CONCLUSION: Through use of an ERP, arthroplasty procedures were successfully resumed at a safety net hospital with a shorter LOS and increased SDDs without a difference in acute adverse events. The resulting increase in healthcare value therefore may be considered a 'silver lining' to the moratorium on elective arthroplasty during the COVID-19 pandemic. These improved efficiencies are expected to continue in post-pandemic era. Cite this article: Bone Jt Open 2021;2(10):871-878.

Elective shoulder surgery during the coronavirus disease 2019 pandemic in Germany: the patients' perspective.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impeded the treatment of elective shoulder patients all over the world. Owing to the constraints in personnel and operation theater capacities, many patients who should undergo planned surgeries could not receive medical care. In our study, we examined the status quo of elective shoulder arthroscopy during the pandemic in Germany. METHODS: Using a nonprofit database, 40 shoulder units that performed the most arthroscopic rotator cuff repairs in Germany in 2018 were identified. Following a standardized protocol, the web pages of these units were screened, and their strategy for elective procedures during the COVID-19 pandemic was analyzed. Special emphasis was put on the use of new digital technologies. RESULTS: At the time of the study, no unit had stopped scheduling appointments for elective shoulder patients because of the pandemic. Almost all units (97.5%) offered explicit information about COVID-19 and their strategies toward it. The possibilities of visiting patients in shoulder units varied owing to local restrictions. Two units (5%) offered digital consultations. CONCLUSION: At the time of the study, elective shoulder procedures could be planned and carried out at the largest centers in Germany. Local restrictions had a great influence on the organization of the procedure and hospital stay during the COVID-19 pandemic. Digital consultations were not available in every unit.

The ongoing impact of COVID-19 on adult cardiac surgery and suggestions for safe continuation throughout the pandemic: a review of expert opinions.

OBJECTIVES: To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery. METHODS: Conduction of a literature search via PubMed using the search terms: '(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)'. Thirty-two articles were selected. RESULTS: Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted 'hot' and 'cold' operating theatres for covid-confirmed and covid-negative patients. CONCLUSIONS: This paper suggests a 'CARDIO' approach for reintroducing elective procedures: 'Care, Assess, Re-Evaluate, Develop, Implement, Overcome'; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load.

An Analysis of Public Interest in Elective Neurosurgical Procedures During the COVID-19 Pandemic Through Online Search Engine Trends.

OBJECTIVE: In the wake of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has recommended the temporary cessation of all elective surgeries. The effects on patients' interest of elective neurosurgical procedures are currently unexplored. METHODS: Using Google Trends, search terms of 7 different neurosurgical procedure categories (trauma, spine, tumor, movement disorder, epilepsy, endovascular, and miscellaneous) were assessed in terms of relative search volume (RSV) between January 2015 and September 2020. Analyses of search terms were performed for over the short term (February 18, 2020, to April 18, 2020), intermediate term (January 1, 2020, to May 31, 2020), and long term (January 2015 to September 2020). State-level interest during phase I reopening (April 28, 2020, to May 31, 2020) was also evaluated. RESULTS: In the short term, RSVs of 4 categories (epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the intermediate term, RSVs of 5 categories (miscellaneous, epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the long term, RSVs of nearly all categories (endovascular, epilepsy, miscellaneous, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. Only the movement disorder procedure category had significantly higher RSV in states that reopened early. CONCLUSIONS: With the recommendation for cessation of elective surgeries, patient interests in overall elective neurosurgical procedures have dropped significantly. With gradual reopening, there has been a resurgence in some procedure types. Google Trends has proven to be a useful tracker of patient interest and may be used by neurosurgical departments to facilitate outreach strategies.

From "business continuity" to "back to business" for orthopaedic surgeons during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient's wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get "back to business" as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article: Bone Joint Open 2020;1-6:222-228.

Practices and attitudes of bariatric surgeons in Israel during the first phase of the COVID-19 pandemic.

INTRODUCTION: Israel ranks very high globally in performing bariatric surgery (BS) per capita. In the first phase of the COVID-19 pandemic the bariatric surgeons' community faced many concerns and challenges, especially in light of a decree issued by the Ministry of Health (MOH) on March 22nd, to ban all elective surgery in public hospitals. The aim of this study is to portray the practices and attitudes of Israeli bariatric surgeons in the first phase of the pandemic. METHODS: Anonymous web-based questionnaire sent to all active bariatric surgeons in Israel. Statistical analysis was performed using SAS software package. RESULTS: 53 out of 63 (84%) active surgeons responded to the survey. 18% practice in the public sector only, 4% in the private sector only and 78% in both sectors. 76% practice BS for more than 10 years and 68% perform more than 100 procedures a year. Almost all the surgeons (98%) experienced a tremendous decrease in operations. Nevertheless, there were substantial differences by sectors. In the public sector, 86% of the surgeons ceased to operate while 14% did not comply with the government's decree. In the public sector 69% of the surgeons were instructed by the administrators to stop operating. The majority of surgeons who continued to operate (77%) changed nothing in the indications or contra-indications for surgery. Among the surgeons who opted to refrain from operating on special sub-groups, the most frequent reasons were pulmonary disease (82%), age above 60 (64%), Ischemic heart disease (55%) and living in heavily affected communities. Roughly only half (57%) of the surgeons implemented changes in informed consent and operating room (OR) measures, contrary to guidelines and recommendations by leading professional societies. When asked about future conditions for reestablishing elective procedures, the reply frequencies were as follows: no special measures - 40%; PCR negativity - 27%; IgG positivity - 15%; waiting until the end of the pandemic- 9%. CONCLUSIONS: We showed in this nation-wide survey that the variance between surgeons, regarding present and future reactions to the COVID-19 pandemic, is high. There were substantial differences between the private and the public sectors. Although the instructions given by the MOH for the public sector were quite clear, the compliance by surgeons and administrators was far from complete. The administrators in the public sector, but more so in the private sector were ambiguous in instructing staff, leading surgeons to a more "personal non-structured" practice in the first phase of the pandemic. These facts must be considered by regulators, administrators and surgeons when planning for reestablishing elective BS or in case a second wave of the pandemic is on its way.