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1.
Cir Esp (Engl Ed) ; 100(6): 352-358, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1944527

ABSTRACT

INTRODUCTION: The COVID-19 pandemic led to the cancellation of non-essential surgical procedures in March 2020. With the resumption of surgical activity, patients undergoing surgery were one of the first population groups to be systematically tested for PCR. The aim of this study was to determine the prevalence of asymptomatic SARS-CoV-2 carriers after the resumption of non-essential surgical activity. METHODS: Retrospective multicenter observational study of patients scheduled for surgery or undergoing emergency surgery in Catalonia between 20 April and 31 May 2020. The microbiological results of preoperative PCR tests and clinical records were reviewed, and an epidemiological survey was conducted on patients with positive PCR for SARS-CoV-2. RESULTS: A total of 10,838 patients scheduled for surgery or who underwent emergency surgery were screened for COVID-19. One hundred and eighteen patients (1.09%) were positive for SARS-CoV-2 in the 72 h prior to surgery. The prevalence of asymptomatic carriers was 0.7% (IC95%: 0.6%-0.9%). The first week of the study presented the highest prevalence of asymptomatic carriers [1.9% (CI95%:1.1%-3.2%)]. CONCLUSIONS: The low levels of asymptomatic carriers of COVID-19 infection obtained in the surgical population of hospitals in Catalonia after the resumption of surgical activity, shows that most patients were able to undergo surgical procedures without the risks of COVID-19 associated complications in the perioperative period.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hospitals , Humans , Pandemics , Prevalence , SARS-CoV-2 , Spain/epidemiology
2.
Front Med (Lausanne) ; 9: 770199, 2022.
Article in English | MEDLINE | ID: covidwho-1938627

ABSTRACT

To manage referrals to the pre-anesthetic consultation during the COVID-19 pandemic, a screening questionnaire was created and sent to parturients with anesthetic risk during the pre-anesthetic consultation. This innovative approach enabled the redistribution of medical anesthetic resources in units that were heavily affected by the pandemic.

3.
Annals of Surgical Oncology ; 29(SUPPL 2):S424, 2022.
Article in English | EMBASE | ID: covidwho-1928243

ABSTRACT

INTRODUCTION: The COVID-19 pandemic peaked in New York City in Spring 2020. From March 20-May 4, all elective operations were suspended due to the number of hospitalized Covid-19 patients. In this study, we sought to describe patterns of care for surgical patients during this time. METHODS: An IRB approved retrospective review was performed of patients who presented to our hospital system from March-May 2020, diagnosed with breast cancer or atypia. RESULTS: We identified 75 patients with breast cancer and 19 patients with atypia. According to standard of care, 55/75 (73%) cancer patients would have undergone upfront surgery. 2/55 (4%) instead were treated with neoadjuvant chemotherapy (NCT), 34/55 (62%) with neoadjuvant endocrine therapy (NET), and 19/55 (34%) had no immediate treatment. 12/19 (63%) with no immediate treatment had DCIS only. 7 had invasive disease, and mean days from diagnosis to surgery was 63 days (range 47-79). One patient had a positive node. A total of 20/75 (27%) patients needed NCT based on advanced stage or molecular profile and had no delay in starting treatment. Of the 34 NET patients, 5 (14.7%) were treated for approximately 6 months and 24 (70.6%) were treated for approximately 6 weeks as a bridge to surgery only. Of the 34 patients who received NET, 5 (14.7%) had an apparent decrease in T stage: 3 patients with clinical T1 disease had no residual disease. 2 had clinical T2 and ultimately had pathological T1 disease. Of the 19 patients with atypia, 6 (31.6%) started chemoprevention preoperatively and 1 patient was already receiving it for a previous LCIS diagnosis. All underwent subsequent surgery and 1/19 (5.3%) patients was upstaged to DCIS. CONCLUSIONS: During the peak of Covid-19, with delay of surgery, we observed an increased utilization of NET when compared to usual treatment patterns, with no apparent adverse effects. While further studies are needed to validate our results, we may see more wide spread use of NET in the future to temporize patients as needed.

4.
J Endourol ; 2022 Jul 05.
Article in English | MEDLINE | ID: covidwho-1922166

ABSTRACT

Purpose: Telehealth utilization has increased dramatically over the past few years due to improvement in technology and the COVID-19 pandemic. To date, no study has examined whether a telehealth visit alone for preoperative evaluation is safe and sufficient before surgery. We examined the safety and feasibility of preoperative telehealth visits alone before minimally invasive urologic surgery. Materials and Methods: Single institution retrospective review of robotic prostate, kidney, and cystectomy procedures between April and December 2020. Cases were dichotomized into those who underwent preoperative evaluation by telehealth only vs traditional in-person visits. Outcomes included complications, blood loss, conversion to open surgery rates, and operative times. We assessed efficiency of care by measuring time from preoperative visit to surgery. Results: Three hundred fourteen patients were included in the study, with 14% of cases (n = 45) being performed after a preoperative telehealth visit. The majority of cases included in analysis were robotic surgeries of the prostate (56.1% of all cases, n = 176) and the kidney (35.0% of all cases, n = 110). Patients seen via telehealth alone preoperatively had no significant differences in any grade of complications, perioperative outcomes, blood loss, operative time, and length of stay. There was no difference in change in anticipated procedure between the groups, and there was no case of conversion to open surgery in the telehealth only group. Time from preoperative visit to surgery was significantly shorter for the telehealth group by 13 days. Conclusions: Our study is the first to analyze the safety of telehealth only preoperative visits before minimally invasive urologic surgery. We found no difference in perioperative outcomes including conversion to open surgery or change in planned procedure. Furthermore, telehealth preoperative visits appeared to facilitate shorter time to surgery. This study has important implications for expediting patient care and medicolegal considerations.

5.
HIP International ; 32(3), 2022.
Article in English | EMBASE | ID: covidwho-1912841

ABSTRACT

The proceedings contain 24 papers. The topics discussed include: applications of 3d models in pelvis and hip surgery;intraoperative fractures of the acetabulum in total hip arthroplasty;does depression influence postoperative total hip atroplasty?;are we meeting patient's expectations after hip preserving surgery?;hip fractures during the COVID-19 pandemic: characteristics, management and outcomes;digital preoperative planning in total hip arthroplasty: our experience;emphysematous osteomyelitis of the hip: a case report;how a tripolar system helps us in revision surgery hip;clinical and radiological risk factors for revision surgery in primary total hip replacement: a study on 4,013 total hip replacements from 2000 to 2020;and peri-prosthetic Vancouver B2 post operative femoral fractures. clinical, functional and radiographic outcomes in a case series.

6.
Surg Case Rep ; 8(1): 124, 2022 Jun 24.
Article in English | MEDLINE | ID: covidwho-1910363

ABSTRACT

BACKGROUND: According to previous reports, in patients with preoperative coronavirus disease 2019 (COVID-19) infection, mortality is increased if they undergo surgery within 6 weeks of diagnosis. However, the optimal timing and preoperative examination for gastrectomy with a previous COVID-19 infection are still controversial. We experienced three cases in which patients successfully underwent open radical gastrectomy following preoperative chemotherapy even though they developed COVID-19 infection during the chemotherapy. CASE PRESENTATION: Case 1: A 58-year-old man with locally advanced gastric cancer caught COVID-19 during preoperative chemotherapy comprising 5-fluorouracil, calcium folate, oxaliplatin, and docetaxel. Although the patient had specific lung shadows indicating COVID-19 infection and deep venous thrombosis in the lower extremities, he underwent distal gastrectomy 10 weeks after the COVID-19 diagnosis. He had a good postoperative course. Case 2: A 56-year-old man with gastric cancer and lymph node and peritoneal metastasis caught COVID-19 during palliative chemotherapy comprising S-1, oxaliplatin, and trastuzumab. He underwent total gastrectomy as conversion surgery 8 weeks after COVID-19 infection. His postoperative course was uneventful. Case 3: A 55-year-old man with gastric cancer and paraaortic lymph node and liver metastases caught COVID-19 during S-1 and oxaliplatin treatment as neoadjuvant chemotherapy. He underwent distal gastrectomy, paraaortic lymph node sampling, and partial hepatectomy 8 weeks after COVID-19 infection although he had residual lung shadows and deep venous thrombosis in the lower extremities. He had an uneventful postoperative course. CONCLUSIONS: Computed tomography for preoperative evaluation was performed for all three patients and revealed that lung shadows remained post-COVID-19 infection. Despite this finding, the patients had good operative courses and were discharged as planned. Surgery after 7 weeks from the diagnosis of COVID-19 infection can be performed safely even when patients are post-chemotherapy and have residual lung findings and deep venous thrombosis. This report may contribute to the development of a consensus on performing safe gastrectomy for advanced gastric cancer in patients previously infected with COVID-19.

7.
Perioper Care Oper Room Manag ; 28: 100271, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1905587

ABSTRACT

Objectives: The COVID-19 pandemic caused primary disruption of health services, especially to elective surgery. As the pandemic goes in waves of high and low infection rates in a country, restarting elective surgery must be dynamic while balancing patients' needs, staff safety and the hospital capacity. We aim to report the prevalence of elective surgery and minimally invasive procedures cancelation due to positive Covid-19 screening and describe steps in restarting elective cases after the third wave of Covid-19 infection. Methods: This study was a descriptive cross-sectional study in Indonesia's tertiary referral and teaching hospital from January to September 2021. Subjects were patients scheduled for elective surgery or minimally invasive procedures from our outpatient clinic. Subjects were screened for SARS-CoV-2 using real-time polymerase chain reaction (rRT-PCR) 24-48 hours before scheduled surgery or intervention. Data was taken from the hospital information system and the central operating theatre online surgical list. Statistical analysis is presented in percentage. Results: There were 5286 subjects identified for the study, and 3088 were included with an available PCR result from the outpatient department. The average elective cancelation rate was 7.4%, and the highest cancelation was on August 2021, with 14.7%. All subjects with positive results were asymptomatic, with more than 90% cycle time rRT-PCR above 30. Conclusion: Elective surgery cancelation can reflect a trend in community infection, and monitoring its values is crucial for saving elective surgery plans during a pandemic.

8.
Age and Ageing ; 51, 2022.
Article in English | ProQuest Central | ID: covidwho-1901093

ABSTRACT

Introduction One might refer to urologists as the ‘hidden providers’ of geriatric care, ultimately sought out by many geriatric patients. POPS, the Peri-Operative care of Older People’s Service started at Guys Hospital in London is often quoted as the gold standard for liaison services. Having set up liaison services in Orthopaedics and General Surgery in my previous job, an exciting opportunity arose after the first COVID—19 wave when I found my new office directly under the Urology Assessment Unit. Method A Geriatric Urology liaison service was set up by a Consultant Geriatrician with SpR support. One hour per week was agreed within the department to pilot the service. By May 2021 the service had been running for 8 months. During this period 30 patients had been seen (36 patient visits). Results The patient’s mean age was 82 years. The advice given included: O Stopping medication (7 cases) O Recommending iron infusions instead of tablets (5 cases) O Adjusting analgesia (4 cases) O Ordering brain imaging (3 cases) Commonly there was the recognition of the need for palliative care in this frail population. There have been complex cases: O A gentleman with a large perinephric bleed. O A young man with seizures and cognitive issues following renal stones. O A patient with post-operative rhabdomyolysis following nephrectomy. Pre-operative assessments have now been started as part of enhanced care: O Two cystectomy patients (one ward/one telephone) O Two TURBT patients (one with low sodium). Conclusion Staff feedback has been excellent especially linking to the Palliative Care Team. We presented our data at the Urology governance meeting in September 2021 and again received excellent feedback. The urology staff have felt increasingly supported. Data collection has helped build a business case for two Consultant posts in surgical liaison.

9.
Diseases of the Colon and Rectum ; 65(5):179-180, 2022.
Article in English | EMBASE | ID: covidwho-1894227

ABSTRACT

Purpose/Background: COVID-19 has caused significant surgical delays as institutions mitigate patient interaction with hospital settings to slow the spread of the pandemic. We aimed to assess changes in surgical access and associated outcomes during the COVID-19 pandemic within the Division of Colorectal Surgery. Hypothesis/Aim: We aimed to determine factors associated with surgical timing, access, and post-operative outcomes when comparing surgeries before the COVID-19 pandemic and during. Methods/Interventions: Patients who underwent colorectal surgery Jan 2018 to Jul 2021 at a tertiary care academic center in Alabama were reviewed via billing data. Clinic visits billed as New Patient visits closest to the date of surgery and <120 days from surgery were determined to be pre-operative visits. Days from pre-operative visit to surgery was time-tosurgery (TTS). Cases before Mar 17, 2020 were the control cohort;cases after were the case cohort. Post-operative outcomes included hospital length of stay (LOS). Linear and logistic regression were used to determine factors associated with the primary outcome, TTS, and the secondary outcome of case cohort factors. Results/Outcome(s): Overall (n=779), patients were 70% White and 25% Black, 56% female, 41% privately insured, 32% insured via Medicaid, with mean age of 56 yr (SD=16). Cases were 64% inpatient, 55% laparoscopic, 32% EUA, 12% Open, and 26% for cancer. Mean TTS was 26 days (SD=24). Mean LOS was 3.6 days (SD=4.8). On bivariate analysis, patients in the case cohort were younger (53 vs 59 yr, p<0.001) and more privately insured (46% vs 36%, p<0.001) compared to patients in the control cohort. Surgeries were less likely to be for cancer (23% vs 29%, p = 0.06). LOS was shorter during the case period (3.1 vs 3.9 days, p=0.02). There were no differences in TTS (25 vs 27 days, p=0.14). On multivariable linear regression, non-Black or White race (Asian, Hispanic, and Other grouped, n=38) was associated with increased TTS (coeff: 11.0, 95% CI: 3.1-18.9). Increased TTS was associated with increased LOS (coeff: 0.4, 95% CI: 0.0-0.8). On multivariable logistic regression, patients in the case cohort were more likely to be younger (OR: 0.98, 95% CI: 0.97-1.0), and less likely to be insured with Medicaid (OR: 0.57, 95% CI: 0.39-0.83). Limitations: Pre-operative visits are approximated by billing data. Delays in surgery and post-operative outcomes are affected by additional variables not included in the billing data. Conclusions/Discussion: Increased TTS is associated with increased LOS. During the COVID-19 pandemic, case volumes have decreased. Patients receiving surgery are younger and more privately insured, indicating disparities in surgical access among the colorectal population. However it appears that TTS was not significantly different when averaged over the pandemic. Additional research is needed to determine the reasons for surgical delay and if delays were different in other specialties.

10.
Ambulatory Surgery ; 28(1):8-10, 2022.
Article in English | EMBASE | ID: covidwho-1893983

ABSTRACT

The COVID-19 pandemic has affected the UK in many ways;with the NHS being put under unprecedented pressure. It led to the cessation of elective surgery for months;causing a back log of deteriorating patients. With the introduction of COVID vaccines and a call for return to normality, new ways of delivering elective surgery to waiting patients, presents an opportunity to find sustainable ways to ensure continuity of treatment in an unstable health economy. The challenges of Covid to ambulatory surgery are outlined and strategies to overcome these challenges discussed.

11.
Enhanced Recovery after Surgery (ERAS) in Bariatric Surgery ; : 1-19, 2021.
Article in English | Scopus | ID: covidwho-1887705

ABSTRACT

Obesity is a challenge for the patient itself, the family’s patients the clinical approach, and the surgery team. Also for the society economically, politically, and as a health pandemic illness. Nothing statically has been more for sure in the obesity ill than the complications related. And now in the settings of these new contexts that imply the SARS-COV 19 pandemic complications which means a new wide window that we need to close trying to avoid the fatalities that would be a high cost to pay for everyone. For these reasons and others well known the patients seeking an obesity surgery must be more than ever well informed and with a highly accurate psychological profiling looking the best treatment for each patient in their settings. And avoid cooking recipes. Now it is a challenge for everyone. In this chapter, we are going to boarding the basic information pre-op for those patients, like expectations, possible risk, and complications, and at the same time an accurate psychologist profile for the best surgical bariatric alternatives. This is a revisional literature chapter looking for the different knowledge among the data published around the world and time. © 2021 by Nova Science Publishers, Inc.

12.
Journal of Cardiovascular Disease Research ; 13(1):884-893, 2022.
Article in English | EMBASE | ID: covidwho-1887445

ABSTRACT

The prevalence of Pheochromocytoma in pat ient with hypertension is 0.1 -0.6%. These types of tumours are known for unpredictable perioperative course and hemodynamic instability. Various different drugs and anaesthesia techniques can be used to tackle these situations. Dexmedetomidine is emerged as newer agent with better hemodynamic stability, reducing requirement of other anaesthesia drugs, blunting of sympathoadrenal response in resection of Pheochromocytoma. We report four cases operated between January 2021 to June 2021.Preoperative preparation was done with α and β blockade. Dexmedetomidine was used during induction as 1 mcg/kg over 10 mins followed by 0.7mcg/kg/hr intraoperatively. Combination of Dexmedetomidine, Fentanyl, NTG, Isoflurane and Epidural analgesia was used. IF needed boluses of Esmolol and Labetalol were used during tumor manipulation. All the patients had an uneventful perioperative course. Dexmedetomidine with pre-operative α and β blockade reduce the need of other drugs intraoperatively and can be used as anaesthetic adjunct to maintain steady hemodynamic.

13.
Clin Ophthalmol ; 16: 1773-1781, 2022.
Article in English | MEDLINE | ID: covidwho-1883794

ABSTRACT

Purpose: To assess the effectiveness of a local infection control protocol for cataract surgery (CS) during the coronavirus disease (COVID-19) pandemic and determine the trend of CSs and visual outcomes during this period, as compared to the pre-COVID-19 pandemic period. Methods: This study was conducted at Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand, between July 1, 2020, and March 31, 2021. In this two-phase study, we used only a COVID-19-screening questionnaire during the first phase and preoperative nasopharyngeal swab severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing for real-time reverse transcriptase-polymerase chain reaction in the second phase, during Thailand's second COVID-19 wave. Nasopharyngeal swab SARS-CoV-2 nucleic acid testing, SARS-CoV-2 IgG/IgM, or anti-SARS-CoV-2 spike antibody seroconversion was used to detect COVID-19 infection among healthcare workers. We also compared cataract surgical volume and postoperative visual acuity of CS patients between the pre-COVID-19 period and during the COVID-19 pandemic period. Results: A total of 947 patients underwent CS. Thirty-two healthcare workers and 275 patients tested negative for SARS-CoV-2 in the second study phase. CSs increased on average by 50.09% month-to-month when the surgery was resumed. The mean postoperative logMAR best-corrected visual acuity was significantly better in the COVID-19 pandemic period than in the pre-pandemic period (difference, 0.1 [95% CI: 0.00-0.12], p < 0.0001). Conclusion: CS could be safely performed under an infection control protocol during the COVID-19 pandemic. The cataract surgical volume, with favorable visual outcomes, has an increasing trend after resuming elective surgeries.

14.
Anestezi Dergisi ; 30(2):104-111, 2022.
Article in Turkish | EMBASE | ID: covidwho-1885093

ABSTRACT

Objective: To evaluate the knowledge and opinions and increase awareness of anesthesia residents and specialists about the timing of elective surgery of patients who have had COVID-19. Methods: After the approval of the hospital ethics committee, the link of the questionnaire form was sent to the anesthesia residents and specialist online via e-mail and social media application (WhatsApp mobile application). Questions were asked regarding demographic data, sources of information regarding COVID-19 infection, timing of elective surgery, preoperative preparation and risk factors, and informed consent. Results: In the study, 78% were specialist physicians, 66% were in the 30-50 age range and 63% were female of the 174 participants. The most used resource was the Ministry of Health Guidelines (79% specialist, 63% resident). Among the information sources used, hospital and in-clinic training, World Health Organization website and scientific publications responses were significantly different between the groups (p=0.002;p=0.015 and p=0.013). The times of taking elective surgery after COVID-19;While the responses of specialists and residents were significantly different in asymptomatic patients, they were found to be similar in patients with symptomatic disease at home, symptomatic in hospital and in intensive care unit. Conclusion: Responses of specialists and residents about the timing of the operation;while it was significantly different in asymptomatic patients, it was found to be similar in those who had symptomatic disease at home and in the hospital and those who had admitted to intensive care.

15.
Int Urogynecol J ; 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1872400

ABSTRACT

INTRODUCTION AND HYPOTHESIS: It is not known whether the measurements of pelvic organ assessment under anesthesia accurately estimate prolapse severity. We compared Pelvic Organ Prolapse Quantification (POP-Q) measurements in the office to exams under anesthesia. METHODS: We prospectively enrolled patients undergoing prolapse surgery between February 2020 and July 2020. POP-Qs at rest and with Valsalva were performed at pre- and postoperative visits. POP-Q under anesthesia was performed, without traction, at the start of case (pre-surgical), following apical suspension, and at the end of case (post-surgical). Primary outcome was change in POP-Q between the office and operating room. Due to the COVID-19 pandemic, additional patients were recruited to maintain the follow-up time frame. RESULTS: Out of 66 patients, 63 underwent surgery and 33 had postoperative exams within 6 weeks. Mean age was 61.3 ± 11.9 years, and mean BMI was 28.4 ± 6.5 kg/m2. Preoperative Aa, Ba, C, Ap, Bp, and D with Valsalva had greater descent than pre-surgical measurements. However, preoperative Gh with Valsalva (4.1 ± 1.3 cm) was not different from pre-surgical Gh (4.0 ± 1.0 cm) (P = 0.60). Postoperative Aa, Ba, Ap, Bp, and D were not different from post-surgical measurements. In contrast, postoperative Gh at rest (2.3 ± 0.7 cm) and with Valsalva (2.4 ± 0.8 cm) were both narrower than post-surgical Gh (2.8 ± 0.6 cm) (P < 0.05). Gh was also narrowed after apical suspension (3.6 ± 1.0 cm, P = 0.005) prior to posterior repair. CONCLUSIONS: Surgeons should rely on preoperative POP-Q for surgical decisions. Gh should be reassessed after apical suspension, and further correction should consider that Gh may be exaggerated compared to the measurement postoperatively when the patient is awake.

16.
Cleft Palate-Craniofacial Journal ; 59(4 SUPPL):58, 2022.
Article in English | EMBASE | ID: covidwho-1868931

ABSTRACT

Background/Purpose: COVID-19 fundamentally changed cleft teams' ability to care for their patients. This study aims to study;1) the effect of COVID-19 on elective surgery timings and outcomes;2) preoperative screening and isolation protocols;3) the impact of operating with personal protective equipment (PPE). Methods/Description: Between the start of the first UK lockdown in March 2020 and April 2021 operative details from 651 cleft procedures performed in eight UK centres were entered into a secure REDCap database. Results: 651 records were entered (59% male, 41% female). 9% patients had a known syndrome. Operations were as follows: cleft palate repair (40%), unilateral cleft lip repair +/- vomer flap (23%), alveolar bone grafting (16%), secondary speech surgery (10%), fistula repair (3.7%), lip revision (1%) and rhinoplasty (1%). 39% of surgical cases were deemed delayed compared to normal protocol timings, with 80% of the delays attributable to COVID. Mean age at initial cleft lip repair was 230 days exceeding a previous representative mean of 137 days as well as breaching the UK national standards for upper age limit of 183 days. Mean age at cleft palate repair was 387 days compared to the UK national standard for upper age limit of 396 days, and previous representative mean of 320 days. 81% of patients undertook some form of pre-operative isolation;47% isolated for two weeks. COVID screening was performed in the 72 hrs prior to surgery in 89% of patients and 13% of parents/carers. Only one patient had a positive test. 69% surgeons wore an FFP3 (N99) mask to operate, and 64% of cases involved difficulty during the operation as a result of the PPE;most commonly communication difficulties (45%). No patients developed COVID in the early post-operative period. Conclusions: This data demonstrates that initial cleft lip and palate repair in the UK has been delayed as a direct result of the COVID-19 pandemic. Secondary surgery has been significantly affected and efforts will need to be made at national level to provide capacity to catch up. Isolation and testing protocols for COVID-19 vary from unit to unit, but appear safe. Routine cleft surgery can safely continuing through the pandemic, as long as appropriate infection control measures are followed and resources allow.

17.
Breast Cancer Res Treat ; 194(2): 475-482, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1866639

ABSTRACT

PURPOSE: The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic. METHODS: Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in the later part of the COVID pandemic. RESULTS: Average monthly breast cancer incidence was 19.3 (95% CI 19.1-19.5) cases per 100,000 women and men pre-COVID, 11.6 (95% CI 10.8-12.4) per 100,000 in April-May 2020, and 19.7 (95% CI 19.3-20.1) per 100,000 in June 2020-February 2021. Use of pre-operative systemic therapy was 12.0% (11.7-12.4) pre-COVID, 37.7% (34.9-40.7) for patients diagnosed March-April 2020, and 14.8% (14.0-15.7) for patients diagnosed May 2020-January 2021. The changes in breast cancer incidence across the pandemic did not vary by demographic factors. Use of pre-operative systemic therapy across the pandemic varied by geographic region, but not by area socioeconomic deprivation or race/ethnicity. CONCLUSION: In this US-insured population, the dramatic changes in breast cancer incidence and the use of pre-operative systemic therapy experienced in the first 2 months of the pandemic did not persist, although a modest change in the initial management of breast cancer continued.


Subject(s)
Breast Neoplasms , COVID-19 , Adult , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , COVID-19/epidemiology , Early Detection of Cancer , Female , Humans , Insurance, Health , Male , Pandemics
18.
B-ENT ; 16(1):73-80, 2020.
Article in English | EMBASE | ID: covidwho-1863153

ABSTRACT

The COVID-19 pandemic has raised unprecedented challenges for all types of medical personnel and health care workers. The avidity of the novel coronavirus for oropharynx and nasopharynx renders otolaryngologists at particular risk of infection. Therefore, the resumption of elective otological care requires personal protective equipment (PPE), thorough (pre)screening and irrefutable hand hygiene. A literature search was conducted on May 5th, 2020. All recommendations concerning otological ENT (Ear Nose Throat), both during outpatient consultation and in the operating theatre, were scored for abundance. Highly recurrent advice was using PPE during each patient encounter, social distancing in the waiting room and teleconsultation before each consultation. Concerning audiological testing, most articles advised social distancing during testing and remote hearing screeners. For resumption of elective otological surgery, preoperative screening, adequate PPE, and minimal staffing to reduce the contamination risk were most frequently advised. Awaiting an effective vaccination for the novel coronavirus, all elective otological health care requires critical appraisal of each case to assess the infectious risks for both patient and health care personnel.

19.
World Journal of Laparoscopic Surgery ; 15(1):87-89, 2022.
Article in English | EMBASE | ID: covidwho-1863136

ABSTRACT

Aim: In April 2020 routine elective surgery in England was suspended in response to coronavirus disease-2019 (COVID-19). Low COVID-19 infection and mortality rates in the South West of England allowed urgent elective surgery in Plymouth to continue with the necessary precautions. The aim of this study was to assess outcomes following elective laparoscopic cholecystectomy during the initial phase of the COVID-19 pandemic. Materials and methods: Records of 54 consecutive patients undergoing urgent elective laparoscopic cholecystectomy between March 25, 2020, and June 25, 2020, were analyzed retrospectively. Patients were telephoned after 30 days. All patients underwent COVID-19 swab testing 24 to 72 hours prior to surgery and during admission if clinically indicated. The primary outcome measure was COVID-19 related morbidity. Secondary outcome measures were non-COVID-19 related morbidity, mortality, and length of hospital stay. Results: Fifty-four patients [19 male, 35 female;median age 59 years (20–79);median body mass index (BMI) 31 kg/m2 (22.9–46.8);median ASA 2] underwent laparoscopic cholecystectomy during the study period. Fifty-one patients (94%) were of White-British ethnicity. One patient tested positive for COVID-19 preoperatively. There were no COVID-19 diagnoses postoperatively and no COVID-19 related morbidity. There were no deaths at 30 days. Forty-four patients (81%) had a day-case procedure. Forty-two (78%) procedures were performed by a supervised trainee. Conclusion: Elective laparoscopic cholecystectomy can be performed safely and training maintained in areas of low COVID-19 prevalence with the necessary precautions. Clinical significance: This small study provides some evidence to aid decision-making around the provision of elective surgical services during this ongoing pandemic.

20.
British Journal of Haematology ; 197(SUPPL 1):153, 2022.
Article in English | EMBASE | ID: covidwho-1861243

ABSTRACT

We present the case of a 39-year-old female who presented to University Hospitals of Leicester 14 days after the second dose of ChAdOx1 nCov-19 vaccine. Her presenting symptoms included skin rash, nausea, intermittent abdominal pain and occasional episodes of dizziness. Her past medical history included Type 2 Diabetes Mellitus and hidradenitis suppurativa. The first dose of ChAdOx1 nCov-19 vaccine had been administered on 27th February 2021, following which the patient reported flu like symptoms that resolved after four days and did not require further medical input. Following this, a preplanned surgical procedure to incise and drain a vulval abscess was performed on 17th May 2021. Preoperative testing performed on 13th May 2021 showed a normal platelet count of 219 × 10 9 /l. The second dose of ChAdOx1 nCov-19 vaccine was subsequently administered on 23rd May 2021. On presentation, examination revealed mild epigastric tenderness and features of classical thrombocytopenic rash affecting all limbs with no other associated bleeding. Initial blood results confirmed thrombocytopenia of 11 × 10 9 /l, with D-Dimer 14.26 μg/ml and fibrinogen 2.1 g/l. Blood film microscopy revealed an occasional schistocyte and microangiopathic haemolysis was considered. Treatment with plasmapheresis of 1.5 x plasma volume using Octaplas was administered. Subsequent abdominal computed topography imaging identified extensive thrombotic events. This included bilateral pulmonary embolism, superior mesenteric vein non-occlusive thrombus and multiple soft atheromas lining the abdominal aorta causing moderate infrarenal stenosis. In view of the recent history, vaccine associated thrombosis and thrombocytopenia (VITT) was considered. Subsequent testing showed a normal ADAMTS13 level. Treatment for VITT with intravenous immunoglobulin along with oral steroids and anticoagulation using Argatroban was commenced in line with national guidance. Anti-PF4 antibody, tested using the Asserachrom HPIA ELISA assay, was positive at a level of 1.298 OD units confirming the diagnosis of VITT;the first case we are aware of in the UK following second dose administration. Given high-risk presentation, Rituximab therapy was given as an inpatient with good clinical response. Prior to discharge, anticoagulation was switched to oral apixaban with a platelet count on discharge of 170 × 10 9 /l. Subsequent follow-up has shown ongoing clinical remission with consistently negative Anti-PF4 antibody titres. This report outlines the first known definite case of VITT identified following administration of the second dose of ChAdOx1 nCov-19 vaccine in the United Kingdom. The subsequent clinical course was similar to those of patients presenting after their first dose but the atypical presentation mimicking that of Thrombotic Thrombocytopenia is noted..

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