The effect of the COVID-19 pandemic on non-elective otolaryngology admissions and a positive change in clinical practice.

As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.

Utilizing Outpatient Pelvic Reconstructive Surgery in the Era of the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has created a significant strain on the medical system, creating resource scarcity. We sought to demonstrate the reduction in hospital room utilization after implementation of outpatient pelvic reconstructive surgery. METHODS: We included all minimally invasive reconstructive surgical procedures in this retrospective cohort study within a large managed care organization of 4.5 million members (2008-2018). We queried the system-wide medical record for Current Procedural Terminology (CPT), International Classification of Diseases, Ninth Revision (ICD-9), and International Classification of Diseases, Tenth Revision (ICD-10) codes for all included procedures and patient perioperative data. Categorical variables were compared using χ2 test for categorical variables and the Kruskal-Wallis test for continuous variables. RESULTS: Of the 13,445 patients undergoing pelvic reconstructive surgery, 5,506 were discharged the same day, whereas 7,939 were discharged the next day. Over the 10-year period, patients without hysterectomy had outpatient surgery rates increase from 31.2% to 76.4% (+45.2%), whereas those with hysterectomy increased from 3% to 56.4% (+53.4%). Hospital room utilization decreased by 45,200 room days/100,000 reconstructive procedures without hysterectomy and 53,400 room days/100,000 reconstructive procedures with hysterectomy. When compared to 2008, in 2018 after more widespread adoption of outpatient elective surgery, for the 738 patients undergoing surgery without hysterectomy, 334 less room days were used, whereas 335 less room days were used among the 640 patients who had a surgical procedure with hysterectomy. CONCLUSIONS: The implementation of outpatient pelvic reconstructive procedures leads to a significant reduction in hospital room utilization. Same-day discharge decreases hospital resource utilization, therefore improving hospital access, which may be essential for the delivery of routine care during times of resource scarcity such as the COVID-19 pandemic.

Patients, procedures, and PPE: Safe office-based anesthesia recommendations in the COVID-19 era.

The growth of office-based surgery (OBS) has been due to ease of scheduling and convenience for patients; office-based anesthesia safety continues to be well supported in the literature. In 2020, the Coronavirus Disease 19 (COVID-19) has resulted in dramatic shifts in healthcare, especially in the office-based setting. The goal of closing the economy was to flatten the curve, impacting office-based and ambulatory practices. Reopening of the economy and the return to ambulatory surgery and OBS and procedures have created a challenge due to COVID-19 and the infectious disease precautions that must be taken. Patients may be more apt to return to the outpatient setting to avoid the hospital, especially with the resurgence of COVID-19 cases locally, nationally, and worldwide. This review provides algorithms for screening and testing patients, selecting patients for procedures, choosing appropriate procedures, and selecting suitable personal protective equipment in this unprecedented period.

Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic.

BACKGROUND: The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS: A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS: There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS: Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.

COVID-19: Role of Ambulatory Surgery Facilities in This Global Pandemic.

Coronavirus disease 2019 (COVID-19) has now become a global pandemic. This has led the United States to declare a national emergency and resulted in a ban on all elective diagnostic and therapeutic procedures as well as elective surgery in inpatient and outpatient settings. Ambulatory surgery facilities (ASF) that perform only elective procedures are thus likely to be closed. However, these facilities may be able to assist acute care hospitals as essential (urgent and emergent) surgeries and diagnostic and therapeutic procedures will still need to be performed. The aim of this article is to explore the potential contribution of ASFs in the current health care crisis. It is important to understand that COVID-19-related information is continually evolving, and thus, the discussion provided here is subject to change.