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OBJECTIVE: The outbreak of COVID-19 and the sudden increase in the number of patients requiring mechanical ventilation significantly affected the management of neurooncological patients. Hospitals were forced to reallocate already scarce human resources to maximize intensive care unit (ICU) capacities, resulting in a significant postponement of elective procedures for patients with brain and spinal tumors, who traditionally require elective postoperative surveillance on ICU or intermediate care wards. This study aimed to characterize those patients in whom postoperative monitoring is required by analyzing early postoperative complications and associated risk factors. METHODS: All patients included in the analysis experienced benign or malignant cerebral or intradural tumors and underwent surgery between September 2017 and May 2019 at University Hospital Münster, Germany. Patient data were generated from a semiautomatic, prospectively designed database. The occurrence of adverse events within 24 hours and 30 days postoperatively-including unplanned reoperation, postoperative hemorrhage, CSF leakage, and pulmonary embolism-was chosen as the primary outcome measure. Furthermore, reasons and risk factors that led to a prolonged stay on the ICU were investigated. By performing multivariable logistic regression modeling, a risk score for early postoperative adverse events was calculated by assigning points based on beta coefficients. RESULTS: Eight hundred eleven patients were included in the study. Eleven patients (1.4%) had an early adverse event within 24 hours, which was either an unplanned reoperation (0.9%, n = 7) or a pulmonary embolism (0.5%, n = 4) within 24 hours. To predict the incidence of early postoperative complications, a score was developed including the number of secondary diagnoses, BMI, and incision closure time, termed the SOS score. According to this score, 0.3% of the patients were at low risk, 2.5% at intermediate risk, and 12% at high risk (p < 0.001). CONCLUSIONS: Postoperative surveillance in cranial and spinal tumor neurosurgery might only be required in a distinct patient collective. In this study, the authors present a new score allowing efficient prediction of the likelihood of early adverse events in patients undergoing neurooncological procedures, thus helping to stratify the necessity for ICU or intermediate care unit beds. Nevertheless, validation of the score in a multicenter prospective setting is needed.
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INTRODUCTION: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. METHODS: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. RESULTS: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. CONCLUSION: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.
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This study aimed to investigate the effects of first dressing changes on the postoperative pain intensity and the duration of pain in patients after anorectal surgeries to provide evidence for improving postoperative pain control. A total of 164 patients with an anorectal disease scheduled to undergo surgery were enrolled in this study, and their postoperative pain levels and duration were recorded. The status of severe pain for a rating score 7 during hospitalization after surgery was considered as the study endpoint. The pain score at the first dressing change was recorded and considered a potential risk factor for predicting severe pain during hospitalization by logistic regression analysis. Comparisons of postoperative pain outcomes between patients with a pain rating score 7 or <7 were performed before and after propensity score matching. Severe pain (rating score 7) at the first dressing change was an independent risk factor for severe pain during hospitalization (odds ratio (OR) = 8.33, p < 0.001). Pain on the first night after surgery in the Severe group was higher than in the Non-Severe group (3.2 +or- 0.9 vs. 2.8 +or- 1.0, p = 0.006). Patients in the Severe group had higher pain number rating scale (NRS) scores at the second (5.2 +or- 1.3 vs. 3.1 +or- 1.2, p < 0.001) and third (3.5 +or- 1.5 vs. 1.9 +or- 0.9, p < 0.001) dressing change than those in the Non-Severe group. Moreover, the overall NRS pain score during hospitalization in the Severe group was significantly higher than the Non-Severe group (5.7 +or- 1.1 vs. 3.9 +or- 1.5, p < 0.001), and the incidence of severe postoperative pain during hospitalization was also higher (61.6% vs. 12.1%, p < 0.001). In addition, pain duration in the Severe group was significantly longer than in the Non-Severe group (10 (3, 18) vs. 5 (2, 10), p < 0.001). Regarding the distributions of propensity scores, the overall NRS pain score during hospitalization in the Severe group was significantly higher than in the Non-Severe group (5.7 +or- 1.1 vs. 3.8 +or- 1.4, p < 0.001), as well as a higher incidence in severe postoperative pain (61.2% vs. 7.5%, p < 0.001), which was accompanied by a significantly longer pain duration in the Severe group (10 (3, 18) vs. 5 (2, 10), p < 0.001). Moreover, subgroup analysis showed that patients in the Severe group had higher overall pain NRS scores than the Non-Severe group for both the Milligan-Morgan (5.6 +or- 1.5 vs. 4.0 +or- 1.1, p < 0.001) and Thread-ligating (5.8 +or- 1.4 vs. 3.9 +or- 1.0, p < 0.001) surgery groups. Pain intensity at the first dressing change was sociated with the intensity and duration of postoperative pain in patients who underwent anorectal surgery. Thus, proper actions are needed to relieve the pain intensity at the first dressing change.
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Introducción. La condición de pandemia por COVID-19 impactó a la sociedad y los sistemas de salud a nivel mundial. Las adaptaciones institucionales procuraron mantener la calidad de la atención a pesar de un contexto organizacional desfavorable. La apendicitis aguda requirió ser manejada en un nuevo escenario institucional. El objetivo de este estudio fue evaluar la efectividad del tratamiento quirúrgico de la apendicitis durante la pandemia. Métodos. Estudio observacional analítico, retrospectivo, en el que se incluyeron pacientes sometidos a apendicectomía, antes y durante la pandemia por COVID-19. Se evaluaron las complicaciones, infección del sitio operatorio, reingresos y estancia hospitalaria. Adicionalmente, se analizaron los desenlaces en los 3 picos epidemiológicos de la pandemia. Se efectuaron estadísticas descriptivas y analíticas entre los grupos a comparar. Resultados. Se incluyeron 1521 pacientes con apendicitis, 48,3 % operados antes y 51,7 % durante la pandemia. No hubo diferencias entre los grupos en complicaciones (p=0,352), infección del sitio operatorio (p=0,191), reingreso en los primeros 30 días (p=0,605) y estancia hospitalaria (p=0,514). El manejo de la apendicitis durante el tercer pico fue similar a las prácticas habituales. El tiempo de evolución fue mayor durante la pandemia (p=0,04) y los pacientes fueron llevados a cirugía más pronto que previo a la pandemia (p<0,001). Conclusiones. No se evidenció un incremento de complicaciones quirúrgicas, reingresos, estancia hospitalaria ni infección del sitio operatorio en los pacientes operados durante la pandemia. Hubo un efecto favorable para los pacientes como consecuencia de la adaptación institucional en la pandemia por COVID-19
Introduction. COVID-19 pandemic impacted society and health systems worldwide. The institutional adaptations sought to maintain the quality of care in an unfavorable organizational context. Acute appendicitis was required to be managed in a new institutional setting. The effectiveness of surgical treatment of appendicitis during the pandemic was evaluated. Methods. Retrospective analytical observational study, in patients with appendectomy, before and during COVID-19 pandemic. Complications, surgical site infections, readmissions, and hospital stay were evaluated. Additionally, the outcomes in the 3 epidemiological peaks of the pandemic were analyzed. Descriptive and analytical statistics were performed between the groups to be compared. Results. A total of 1521 patients with appendicitis were included, 48.3% before and 51.7% during the pandemic. There were no differences in complications (p=0.352), operative site infection (p=0.191), readmission at 30 days (p=0.605), and hospital stay (p=0.514) between the groups. Management of appendicitis during the 3rd peak was like usual practices. There was a long evolution time during the pandemic (p=0.04) and the patients were taken to surgery sooner than before the pandemic (p<0.001). Conclusions. There was no evidence of an increase in surgical complications, readmissions, hospital stay, and surgical site infections during patients who underwent surgery. There was a favorable effect for patients because of institutional adaptation in the COVID-19 pandemic
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Humans , Appendicitis , Outcome Assessment, Health Care , Coronavirus Infections , Postoperative Complications , Pandemics , Length of StayABSTRACT
Introduction In outpatient surgery, post-discharge follow-up calls are essential for identifying complications and are considered a cost-effective intervention. Currently, there is a lack of scientific evidence to support the development and validation of standardized protocols adjusted to patients' specificities. Our aim is to develop a personalized model for our outpatient surgery unit (OSU) to create an individualized follow-up strategy in the future. Material and methods We performed a retrospective, cohort, single-center study, including patients undergoing surgery at an OSU of a tertiary hospital in Portugal, for three months. Follow-up calls were performed on the seventh and fourteenth days after discharge. The variables analyzed included: sex, age, surgical specialty, anesthetic technique, American Society of Anesthesiologists (ASA) physical status classification, surgery duration, and complications. A binary logistic regression was adjusted for the complications detected in each call. Results Nine-hundred eighty-four (984) patients were included, of which 79.8% (n=785) and 75.3% (n=741) answered the follow-up calls on the seventh and fourteenth days after discharge, respectively. Complications were reported in 47.1% (n=370) and 29.8% (n=221) of these calls, respectively, with pain having the highest incidence rate (44.7% in the first call; 26.6% in the second). The type of anesthesia and surgical specialty were independent risk factors for complications (p<0.001). Each minute increase in surgery duration increased by 1.1% the odds of complications (95% confidence interval 1.003-1.018) in the first call. Compared with no anesthesiology involvement, general anesthesia, regional anesthesia, and monitored anesthetic care are 2.52, 2.04, and 1.75 times more likely to have complications detected in the first call and 3.21, 2.36, and 3.11 times more likely to have complications on the second (p<0.05 for all). A model that predicts the detection of complications in each call was created. Discussion Outpatient surgery may allow procedures to be carried out safely, efficiently, and cost-effectively. To optimize the outcomes, it is important to quantify results as a tool for honing our strategies. The present study recognized the influence of several variables in the incidence of post-discharge complications. Also, considering the complications reported, pain was the most frequent among the reports and should not be neglected. In our reality, no follow-up calls are routinely performed after the seventh day, and complications were reported in that period, meaning some patients probably should be accompanied for a longer period. Conclusions To ensure the quality of care and patient safety and satisfaction, it is essential to identify and manage postoperative complications. Despite not being a routine contact, the incidence rate of complications on the seventh and fourteenth postoperative days is noted. According to our investigation, the type of anesthesia, surgical specialty, and duration of surgery should be carefully considered when establishing individualized follow-up plans. These plans, using tools adjusted to the population of each OSU, such as the calculator presented, may allow the available resources to be used with the greatest potential benefit for both patients and healthcare systems.
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INTRODUCTION: The COVID-19 pandemic has made it difficult to respond to demands in maternal health around the world. Placenta accreta spectrum (PAS) is one of the most severe obstetric conditions and usually requires the use of multiple health resources We describe the clinical results of the management of PAS patients during the COVID-19 pandemic and analyze how the pandemic may affect the functioning of a PAS team. METHODOLOGY: This was a descriptive, retrospective study including all patients treated for PAS in two low- to middle-income country reference hospitals between January 2020 and March 2021. The clinical results of patients with SARS-CoV-2 infection during PAS surgery (Group 1) were compared with those of PAS patients without SARS-CoV-2 infection (Group 2). RESULTS: One hundred forty-five patients undergoing surgery for PAS were included. Group 1 patients (11 cases) showed a longer operative time (250 min, IQR 200-300) and a higher frequency of intra- or postoperative complications (54.5%) than group 2 patients (180 min [IQR 125-240], and 17.9%). CONCLUSION: Placenta accreta spectrum patients undergoing surgery during acute SARS-CoV-2 infection have a higher frequency of postoperative complications. PAS teams must prepare to modify their management protocols to minimize risks for patients and healthcare personnel.
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COVID-19 , Placenta Accreta , Placenta Previa , Pregnancy , Female , Humans , Placenta Accreta/epidemiology , Placenta Accreta/surgery , Retrospective Studies , Pandemics , Hysterectomy/methods , SARS-CoV-2 , Postoperative Complications/surgery , Placenta , Placenta Previa/surgeryABSTRACT
Background and Objectives: Guidelines recommend deferral of elective surgery after COVID-19. Delays in cancer surgeries may affect outcomes. We examined perioperative outcomes of elective cancer surgery in COVID-19 survivors. The primary objective was 30-day all-cause postoperative mortality. The secondary objectives were 30-day morbidity, and its association with COVID-19 severity, and duration between COVID-19 and surgery. Methods: We collected data on age, gender, comorbidities, COVID-19 severity, preoperative investigations, surgery performed, and intra and postoperative outcomes in COVID-19 survivors who underwent elective cancer surgery at a tertiary-referral cancer center. Results: Three hundred and forty-eight COVID-19 survivors presented for elective cancer surgery. Of these, 332/348 (95%) patients had mild COVID-19 and 311 (89%) patients underwent surgery. Among patients with repeat investigations, computerized tomography scan of the thorax showed the maximum new abnormalities (30/157, 19%). The 30-day all-cause mortality was 0.03% (1/311) and 30-day morbidity was 17% (54/311). On multivariable analysis, moderate versus mild COVID-19 (odds ratio [OR]: 1.95;95% confidence interval [CI]: 0.52–7.30;p = 0.32) and surgery within 7 weeks of COVID-19 (OR: 0.61;95% CI: 0.33–1.11;p = 0.10) were not associated with postoperative morbidity. Conclusions: In patients who recover from mild to moderate COVID-19, elective cancer surgery can proceed safely even within 7 weeks. Additional preoperative tests may not be indicated in these patients. © 2022 Wiley Periodicals LLC.
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BACKGROUND: Coronavirus disease 2019 increased the numbers of patients requiring prolonged mechanical ventilation, with a subsequent increase in tracheostomy procedures. Coronavirus disease 2019 patients are high risk for surgical complications. This review examines open surgical and percutaneous tracheostomy complications in coronavirus disease 2019 patients. METHODS: Medline and Embase databases were searched (November 2021), and the abstracts of relevant articles were screened. Data were collected regarding tracheostomy technique and complications. Complication rates were compared between percutaneous and open surgical tracheostomy. RESULTS: Percutaneous tracheostomy was higher risk for bleeding, pneumothorax and false passage. Surgical tracheostomy was higher risk for peri-operative hypoxia. The most common complication for both techniques was post-operative bleeding. CONCLUSION: Coronavirus disease 2019 patients undergoing tracheostomy are at higher risk of bleeding and peri-operative hypoxia than non-coronavirus disease patients. High doses of anti-coagulants may partially explain this. Reasons for higher bleeding risk in percutaneous over open surgical technique remain unclear. Further research is required to determine the causes of differences found and to establish mitigating strategies.
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Introducción. La pandemia de COVID-19 replanteó la forma de atención en los sistemas de salud, afectando todas aquellas patologías no relacionadas con infecciones respiratorias, como la apendicitis aguda. El miedo al contagio por SARS-CoV-2 y las medidas restrictivas a la movilidad pudieron aumentar el tiempo desde el inicio de los síntomas hasta la consulta al servicio de urgencias, derivando en complicaciones intra y posoperatorias. Métodos. Estudio observacional descriptivo de corte trasversal y retrospectivo, donde se incluyeron todos los pacientes diagnosticados con apendicitis aguda llevados a apendicectomía, que fueron divididos en dos grupos, considerados prepandemia, desde el 1° de septiembre de 2018 al 15 de marzo de 2020, y pandemia, desde el 16 de marzo de 2020 al 30 de septiembre de 2021. Resultados. Fueron identificados 1000 pacientes, distribuidos en 501 pacientes en el grupo prepandemia y 499 en el grupo pandemia. El promedio de tiempo de consulta desde el momento de inicio de síntomas hasta consulta fue de 43 horas en el grupo prepandemia y de casi 45 horas en el grupo pandemia. Discusión. A pesar de las restricciones por la enfermedad causada por el nuevo coronavirus y el miedo que puede existir por el contagio, en nuestro centro no se evidenció un cambio en el manejo y presentación de los pacientes diagnosticados con apendicitis aguda
Introduction. The COVID-19 pandemic varied the way health systems were attended, thus affecting pathologies not related to respiratory infections, such as acute appendicitis. Fear of SARS-CoV-2 infection and mobility restrictive measures may have implied a longer time from the onset of symptoms to consultation of the emergency department, leading to intraoperative and postoperative complications. Methods. Retrospective cross-sectional descriptive observational study, identifying all patients diagnosed with acute appendicitis and taken for appendectomy, divided into two groups, considered pre-pandemic, from September 1, 2018 to March 15, 2020, and pandemic, from March 16, 2020 to September 30, 2021. Results. One-thousand patients were identified, 501 patients were distributed in the pre-pandemic group and 499 in the pandemic group. The average consultation time from the time of onset of symptoms to consultation was 43 hours in the prepandemic group and almost 45 hours in the pandemic. Discussion. Despite the restrictions due to the disease caused by the new coronavirus and the fear that may existed due to contagion, in our center there was no evidence of a change in the management and presentation of patients diagnosed with acute appendicitis
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Humans , Appendicitis , COVID-19 , Intraoperative Complications , Appendectomy , Postoperative Complications , Coronavirus Infections , PandemicsABSTRACT
Background: The COVID-19 pandemic period suggests that the rate of complications may have increased in patients requiring surgical treatment due to the fact that they could not come to the hospital at the onset of the symptom. This study aims to evaluate the difference in the frequency of complicated appendicitis and postoperative complications in the COVID-19 pandemic.Patients included those who underwent appendectomy in 1 year before the COVID-19 pandemic and in the first year of the pandemic. The patients were categorized into two groups: pre-pandemic and pandemic periods. Clinical and histopathology results were compared between the pre-pandemic and pandemic periods. Results: A total of 407 patients were included in the study, 207 of whom were included during the pre-pandemic and 200 of whom during the pandemic period. The mean time to hospital admission after the onset of symptoms was 1.3 ± 0.9 days, pre-pandemic, and 1.4 ± 0.8 days during the pandemic group. In the pre-pandemic group, 0.4% intrabdominal abscess developed and 37.5% complicated appendicitis was detected. In the pandemic group, it was found that there were 1% abscess, 0.5% wound infection, 0.5% brid ileus, and 31.9% complicated appendicitis. The pre-pandemic group length of hospitalization was 2.4 ± 0.8 days, and the pandemic was 2.1 ± 0.9 days There was no difference between pre-pandemic and pandemic groups in terms of age, gender, white blood cell count, duration of symptoms, postoperative complications and frequency of complicated appendicitis, and duration of hospitalization. Conclusions: In the first year of the COVID-19 pandemic, we found that the rate of complicated appendicitis and postoperative complications were not different from pre-pandemic.
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PURPOSE: Delay of elective surgeries, such as total joint replacement (TJR), is a common procedure in the current pandemic. In trauma surgery, postponement is associated with increased complication rates. This study aimed to evaluate the impact of postponement on surgical revision rates and postoperative complications after elective TJR. METHODS: In a retrospective analysis of 10,140 consecutive patients undergoing primary total hip replacement (THR) or total knee replacement (TKR) between 2011 and 2020, the effect of surgical delay on 90-day surgical revision rate, as well as internal and surgical complication rates, was investigated in a university high-volume arthroplasty center using the institute's joint registry and data of the hospital administration. Moreover, multivariate logistic regression models were used to adjust for confounding variables. RESULTS: Two thousand four hundred and eighty TJRs patients were identified with a mean delay of 13.5 ± 29.6 days. Postponed TJR revealed a higher 90-day revision rate (7.1-4.5%, p < 0.001), surgical complications (3.2-1.9%, p < 0.001), internal complications (1.8-1.2% p < 0.041) and transfusion rate (2.6-1.8%, p < 0.023) than on-time TJR. Logistic regression analysis confirmed delay of TJRs as independent risk factor for 90-day revision rate [OR 1.42; 95% CI (1.18-1.72); p < 0.001] and surgical complication rates [OR 1.51; 95% CI (1.14-2.00); p = 0.04]. CONCLUSION: Alike trauma surgery, delay in elective primary TJR correlates with higher revision and complication rates. Therefore, scheduling should be performed under consideration of the current COVID-19 pandemic. LEVEL OF EVIDENCE: Level III-retrospective cohort study.
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OBJECTIVE: To retrospectively investigate the association between the non-plan secondary surgery and the nosocomial infection so as to provide objective basis for prevention and control of nosocomial infection in the non-plan secondary surgery patients. METHODS: The medical records of all the patients who received non-plan secondary surgery in a three-A tertiary hospital of Xi'an from Jan 2018 to Dec 2019 were retrospectively investigated. The baseline data, clinical features and status of infection of the non-plan secondary surgery patients were retrospectively reviewed and analyzed by full-time staff of disease prevention and control department. RESULTS A total of 111948 patients underwent surgeries in the whole hospital from Jan 2018 to Dec 2019, 194 of whom underwent the non-plan secondary surgery, accounting for 0.17%. Postoperative hemorrhage was the leading cause of the non-plan secondary surgery, followed by incision infection(57.22%), incision dehiscence(11.34%) and poor healing(8.76%). Among the 194 patients undergoing non-plan secondary surgery, 57 had nosocomial infection, respiratory system, surgical site and blood system were the infection sites, there was 1 case who had nosocomial infection for the first time before the surgery, 24 cases who had nosocomial infection for the first time after the surgery and 32 cases who had nosocomial infection after the secondary surgery. Among the 24 patients who had nosocomial infection for the first time after surgery, 70.83% were male patients, 75.00% had clean-contaminated incision, 66.67% were with the operation duration no less than 3 hours, 75.00% were treated with preoperative antibiotic prophylaxis, and 91.67% were tumor patients. Among the 32 patients who had nosocomial infection after the secondary surgery, 75.00% were male patients, 53.13% were no less than 60 years old, 78.13% were with the operation duration no less than 3 hours, and 68.75% were tumor patients. CONCLUSION: The non-plan secondary surgery and the nosocomial infection are mutually causal, the postoperative surgical site infection for the first time may lead to the secondary surgery, and the secondary surgery may result in the increase of incidence of nosocomial infection.
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Introduction Although a substantial portion of the United States population has been infected with and recovered from Coronavirus Disease-19 (COVID-19), many patients may have persistent symptoms and complications from disease-driven respiratory disease, arrhythmias, and venous thromboembolism (VTE). With institutions resuming elective total joint arthroplasties (TJA), it is unclear whether a prior resolved diagnosis of COVID has any implications on postoperative outcomes. Methods All elective TJA performed in 2021 at our institution were retrospectively reviewed and a history of prior COVID+ result recorded. Baseline demographics, days from prior COVID+ result to surgery date, preoperative methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, and laboratory markers were obtained to determine baseline characteristics. Postoperative estimated blood loss (EBL), length of stay (LOS), rate of revision surgery, and discharge destination were compared between groups. Perioperative and postoperative rates of VTE, urinary tract infection (UTI), pneumonia, postoperative oxygen supplementation, cardiac arrhythmia, renal disease, sepsis, and periprosthetic joint infections within six months of surgery were recorded. Results Of the 155 elective TJA performed in 2021, 24 patients had a prior COVID+ diagnosis with a mean of 253 days from positive result to surgery date. There were no significant differences in baseline demographics, comorbidities, and preoperative lab markers between groups. Surgeries on patients with a prior COVID+ had a significantly higher EBL (260 vs 175cc), but postoperative outcomes of VTE, UTI, pneumonia, oxygen supplementation requirement, nares MRSA+, cardiac disease, and infection rates between groups were similar. Bivariate logistic regression revealed increased days from COVID+ diagnosis (>6 months) to surgery date were associated with a shorter LOS. Conclusion Although a prior COVID+ diagnosis had increased intraoperative blood loss, there were no significant differences in respiratory, infectious, cardiac, and thromboembolic complications up to six months after elective TJA. This study suggests that asymptomatic C+ patients receiving elective TJA do not require more aggressive prophylactic anticoagulation or antibiotic regimens to prevent VTE or perioperative infections. As institutions around the nation resume pre-COVID rates of arthroplasty surgeries, a prior diagnosis of COVID appears to have no effects on postoperative complications.
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INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI. METHODS: We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes. RESULTS: We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5⯱ 4.0 vs pre-COVID 4.6⯱ 4.2, pâ¯= 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, pâ¯< 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, pâ¯= 0.134), major vascular complications (2.3% vs 3.4%, pâ¯= 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, pâ¯= 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, pâ¯= 0.359 and 5.2% vs 5.2%, pâ¯= 0.993, respectively). CONCLUSIONS: During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality.
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Objective: To evaluate the impact of the Covid-19 outbreak on surgical management of musculoskeletal oncology patients. Methodology: A total of 76 patients were identified and included in this observational study for which data was collected from the databases of Hayatabad Medical Complex, Peshawar & Dr. Ruth KM Pfau Civil Hospital, Karachi, Pakistan from March till August 2020. Patients having malignant bone and soft tissue tumours and locally aggressive benign tumours were included in this study. All the patients underwent PCR investigation for SARS-CoV-19 virus pre-operatively and surgeries were performed in PCR negative and asymptomatic PCR positive patients only, with protective equipment.
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Surgical site infection (SSI) is one of the most common and serious hospital-acquired infections all over the world. The SSI can lead to an increase in morbidity, mortality, and increase in the duration of hospital stay among patients. The present systematic review was planned to find the epidemiological features, prevalence, causative organisms, and predisposing risk factors for the development of postoperative infections among surgical patients of all the six WHO regions. Initially, 281 articles were identified through specified databases. Finally, 18 articles that fulfilled all inclusions and exclusion criteria are included. For the risk factors assessment, p-values, odds ratio were considered. In general, the occurrence rate of SSI ranges from 2% to 17.8%. Regarding causative organisms, three microorganisms are commonly reported in most of the studies were Staphylococcus aureus, Klebsiella pneumonia, and E. Coli. Among the different procedures reviewed, incidence and prevalence rates were higher among emergency surgical procedures and lower among obstetrics and gynecology procedures. Longer preoperative duration of stays in hospital decreased Hb and serum albumin level, comorbid conditions such as diabetes, hypertension are potential risk factors for the development of SSI. The occurrence rate of SSI among post-operative patients is very high, especially in developing countries. This leads to a double burden on the healthcare delivery settings during the COVID-19 pandemic. It is essential to include a strict infection control policy, fair usage of antibiotics practices to be implemented. It is also recommended to control comorbid conditions before planning for elective surgery.
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INTRODUCTION: The use of the botulinum neurotoxin injection is a growing area of research and clinical activity, with a focus on its role in facilitating postoperative pain management after reconstructive breast surgery. The study aimed to find out the standard injection points for botulinum neurotoxin injection by revealing the intramuscular nerve arborization of the pectoralis major. METHODS: Sihler's technique was conducted on the pectoralis major muscles (16 cadaveric specimens). The intramuscular nerve arborization was documented relative to the inferior border of the clavicle bone and lateral border of the sternum. RESULTS: After the staining, the pectoralis major was divided into fifths transversely from the inferior border of the clavicle and vertically into fifths from the lateral border of the sternum. Intramuscular nerve arborization of the pectoralis major muscle was the largest in the middle sections of the muscle belly. DISCUSSION: The results indicate that botulinum neurotoxin should be applied to the pectoralis major in certain regions. The regions of major arborization are optimal as the most effective and most reliable points for injecting botulinum neurotoxin.