Emerging From the Pandemic: How Has Academic Surgery Changed?

Academic surgery has changed along with the rest of the world in response to the COVID pandemic. With increasing rates of vaccination against COVID over the past 2 y, we have slowly but steadily made progress toward controlling the spread of the virus. Surgeons, academic surgery departments, health systems, and trainees are all attempting to establish a new normal in various domains-clinical, research, teaching, and in their personal lives. How has the pandemic changed these areas? At the 2022 Academic Surgical Congress Hot Topics session, we attempted to address these issues.

Implementation of Lean Management Tools Using an Example of Analysis of Prolonged Stays of Patients in a Multi-Specialist Hospital in Poland.

Healthcare institutions in Poland constantly encounter challenges related both to the quality of provided services and to the pressures associated with treatment effectiveness and economic efficiency. The implemented solutions have a goal of improving the service quality of lowering the continuously increasing operational costs. The aim of this paper is to present the application of Lean Management (LM) tools in a Polish hospital, which allowed for the identification of prolonged stays as one of the main issues affecting the service costs and the deteriorating financial results of the hospital. The study was conducted in the neurology department and involved an analysis of data for the whole of 2019 and the first half of 2022. In addition, surveys were conducted among the medical staff to help identify the main causes of prolonged stays. Methods of data analysis and feasible solutions were developed in order to improve the economic efficiency of the unit. The analysis shows that the application of LM tools may contribute to improvement in the functioning of hospitals and that further studies should focus on the development of the method to evaluate efficiency of the implemented solutions intended at shortening the hospital stays of the patients.

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic.

OBJECTIVE: The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase. PATIENTS AND METHODS: From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines. RESULTS: 79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21). CONCLUSIONS: Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

Detection of microorganisms in hospital air before and during the SARS-CoV-2 pandemic.

OBJECTIVE: Microorganisms present a global public health problem and are the leading cause of hospital-acquired infections. Therefore, it is essential to study the prevalence of microorganisms in hospital environments. The conclusion from such a study can contribute to identify the areas most likely to be contaminated in a hospital and appropriate measures that can decrease the exposure risk. MATERIALS AND METHODS: The prevalence of microorganisms in hospital air was examined in different departments by obtaining air samples with an impactor before and during the SARS-CoV-2 pandemic. A total of 2145 microorganisms were identified, and the corresponding data were jointly analyzed by area, sampling period, and concentration. RESULTS: The most frequently detected microorganisms in hospital air were Staphylococcus, Micrococcus, Neisseria, and fungi, and the more polluted departments were the hemodialysis department, respiratory department, treatment room, and toilet. Significant differences were found between the concentration of bacteria and fungi before and during the pandemic, which could be related to multiple environmental conditions. Furthermore, SARS-CoV-2 was negative in all the air samples. CONCLUSIONS: Overall, this study confirmed the existence and dynamic characteristics of airborne microorganisms in a hospital. The results contribute to the adaptation of specific measures which can decrease the exposure risk of patients, visitors, and staff.

Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department.

OBJECTIVE: This study focuses on changes in gynecologic surgical activity at Hospital Foch, Paris, France during the first French COVID lockdown in 2020. Additional goals include the evaluation the extent of the postponement suffered for each type of surgery and estimate the possible negative impact for patients. STUDY DESIGN: Single-center, retrospective, chart-review cohort study in the gynecology department of Hospital Foch. Comparison of all patients scheduled, postponed and operated during the first COVID lockdown (March 14, to May 11, 2020) versus the same period in 2019. Postponed surgeries were classified into 4 scheduling interval categories according to the Society of Gynecology Oncology (SGO) recommendations: urgent (without delay), semi-urgent (1-4 weeks), non-urgent (>4-12 weeks) and elective (>3 months) and evaluated to determine whether COVID-19-related delays of surgeries fell within guidelines. The potential "loss of chance" or medical risk associated with postponed surgeries was estimated according to a composite criterion including death, aggravation of expected tumor stages/grades in cancers, increase in surgical complexity compared to that initially planned, need for preoperative transfusions, start of morphine consumption during preoperative treatment for opiate-naive patients, additional hospitalization or consultations in emergency room and delay in treatment when surgery was urgent. RESULTS: During the 2020 French COVID lockdown, 61 patients had a surgical procedure and 114 were postponed; in the comparator 2019 group, 232 patients underwent surgical procedures, indicating an overall decrease of 65% of activity. Analysis of differences between the two years revealed a reduction of 64% in emergency procedures, 90% of functional pathologies, and 13% of cancers. According to SGO guidelines, the only type of surgical procedures that had excessive delay was the semi-urgent group, where time to surgery was 6.7 weeks [range 5.4-10 weeks] instead of the recommended interval of 1-4 weeks. Among postponed surgeries there were 10 patients (8.7%) with a potential "loss of chance" according to the composite criteria, all included in the semi-urgent group. CONCLUSION: The COVID 19 pandemic was responsible for a significant decrease of activity in the surgical department of Hospital Foch. Difficulty of rescheduling surgeries was responsible for an increased delay in semi-urgent operations. In almost 9% of postponed surgeries, there was a potential "loss of chance", which likely represents only the tip of iceberg of collateral damages due to COVID 19 pandemic in this surgical unit. These data show the importance of continuing to treat pathologies requiring urgent or semi-urgent surgery during pandemics.

Development Work in Healthcare: What Supportive and Deterrent Factors Do Employees Working in a Hospital Department Experience in an Improved Work Environment?

Work-related mental health issues, accounting for high worker absenteeism in the world's developed economies, are increasing, with the main cause being workplace conditions. The health services sector is especially experiencing great problems with this, because of challenging psychosocial working conditions. The aim of this study was to explore employees' experiences of development work with a focus on the work environment within a hospital department with an outspoken special development assignment. The special assignment was decided by the highest management at the hospital and concerned work environment, caring processes, and ways of organizing the work. Eleven employees completed two individually semi-structured interviews, approximately 7 and 13 months after the start of the special assignment at the department. Interviews were analyzed using thematic analysis. The results reveal that both internal and external aspects influence the development work and highlight the importance of viewing the local development work in relation to how the rest of the organization functions. Important factors and conditions for a supportive and change-friendly work culture are discussed, as well as the need to plan for integration and change to create conditions for successful implementation of the results from organizational development and change initiatives.

Stress reactions in a tertiary oto-rhino-laryngological department during the first wave of the COVID-19 pandemic in the Danish Capital region.

BACKGROUND: Health care workers (HCW) at otorhinolaryngological departments have an increased risk of contracting COVID-19, due to aerosol-inducing diagnostic and surgical procedures in the airways. The ongoing exposure to physical and psychological stressors could impact the mental health of HCW. AIM/OBJECTIVE: To investigate the impact on mental health in an otorhinolaryngological department during the COVID-19 pandemic. MATERIALS/METHOD: Cross-sectional questionnaire study, assessing symptoms of depression (PHQ-9) and anxiety (GAD-10). Physicians, nurses, and secretaries were included at a tertiary department of otorhinolaryngology in the Capital Region of Denmark during the COVID-19 lockdown in spring 2020. RESULTS: Positive screenings for stress reactions were found in 22% for depressive symptoms and 15.5% anxiety. 27% feared becoming infected, 47% feared infecting their families in relation to work. 27% felt others were distancing from them, and 38% isolated themselves from others because of their work. Women had an odds ratio of 9.18 (CI 1.49-179) for depressive stress reactions. CONCLUSION: HCW were primarily concerned with transmitting COVID-19 to their relatives. Secondarily, there was a concern about becoming infected despite feeling adequately protected by personal protective equipment. Women were at higher risk of more severe depressive symptoms when corrected for professions.

#Neurosurgery: A Temporal and Content Analysis of Academic Neurosurgery on Twitter.

BACKGROUND: Social media has become ubiquitous in modern medicine. Academic neurosurgery has increased adoption to promote individual and departmental accomplishments, engage with patients, and foster collaboration. We sought to quantitatively evaluate the adoption of one of the most used social media platforms, Twitter, within academic neurosurgery. METHODS: A quantitative and qualitative analysis of Twitter use across 118 academic neurosurgery departments with residency programs in the United States was performed in March 2019 and March 2021. We collated Twitter handles, Doximity residency ranking (a peer-determined ranking system), geographic location, and Twitter demographics (tweets, followers, likes, and tweet content) from before and after the coronavirus disease 2019 (COVID-19) pandemic. Tweet content was characterized by reviewers over a predetermined 6-month period. Linear regression and parametric/nonparametric tests were used for analysis. RESULTS: Departmental accounts grew 3.7 accounts per year between 2009 and 2019 (R2 = 0.96), but 43 accounts (130%) were added between 2019 (n = 33) and 2021 (n = 76). This growth, coinciding with the COVID-19 pandemic, changed the model from linear to exponential growth (R2 = 0.97). The highest-ranking programs based on Doximity were significantly more likely to have an account (P < 0.001) and have more followers (P < 0.0001). Tweet content analysis revealed prioritization of faculty/resident activity (mean 49.9%) throughout the quartiles. CONCLUSIONS: We demonstrate rapid uptake in Twitter use among U.S. academic neurosurgical departments, accelerated by COVID-19. With the impact of COVID-19, it is clear that there will be continued rapid adoption of this platform within neurosurgery, and future studies should explore the outcomes of peer collaboration, patient engagement, and dissemination of medical information.

[Survey about the impact of COVID-19 on the traumatology and orthopedic surgery departments in Spain]. / Encuesta acerca del impacto de la COVID-19 en los servicios de Cirugía Ortopédica y Traumatología de España.

INTRODUCTION: We designed and conducted a survey to analyze the impact of the COVID-19 pandemic on the operation and performance of the orthopedic departments of the National Health System and private entities. MATERIAL AND METHODS: Descriptive study of a survey is distributed to Spanish Ortohopedic surgeons via Internet. RESULTS: 401 valid responses were obtained, out of these 85.7% had to reduce their surgical activity between 50% and 100%. 46% of the sample were asked to collaborate in other units or services and another 43% felt that their work had been underused. 52% modified the treatment indications in various bone fractures, with variability between centers and communities. 30% reported being satisfied with the management from the state and 60% with that of their province and center. 70% showed little to no satisfaction with the training received on the use of masks and personal protective equipment. An additional of 80% were also unsatisfied with the training received with regard to sample-taking. 65% did not have protective equipment to carry out their work. 46% have been denied protective measures to treat patients with suspected or confirmed infection. CONCLUSION: The COVID-19 pandemic has placed the National Health System in an extremely serious situation. Through the analysis of the results, we can observe an inefficient use of available human resources, a widespread discontent, as well as an absence of means and measures, which has had a direct impact on the number of infected professionals.

[Impact of the SARS-CoV-2 pandemic on a human milk bank]. / Impacto de la pandemia por SARS-CoV-2 en un banco de leche humana.

INTRODUCTION: Introduction: the pandemic caused by SARS-CoV-2 led to the declaration of the state of sanitary alarm between March and June 2020 in Spain. The activity of human milk banks was affected during that period, making it necessary to implement new measures in order to promote milk donation and diminish said impact. Method and objective: the aim of the study was to evaluate the impact of the state of alarm decreed from March 14 to June 22, 2020 on the breastmilk bank at Hospital Virgen de las Nieves, Granada, Spain, in comparison with the same period during the previous year. To that end, a retrospective descriptive study was undertaken in which the activity indicators of the breastmilk bank were collected and compared to data from the milk bank at Hospital Virgen de las Nieves and peripheral collaborating centers. Results: during the first state of alarm in 2020 a global reduction was seen in new donor registrations, number of donors who donated milk, donated mean volume per mother, and total volume of received and pasteurized milk. However, new registrations and number of donors who donated milk during this period increased in Granada's breastmilk bank. Discussion: the new measures adopted in the breastmilk bank in Granada, such as encouraging milk donation in mothers with admitted newborns in the Neonatal Unit, increasing information given to mothers, and home collection of donated milk, allowed to attenuate the impact of the pandemic while guaranteeing safety.

INTRODUCCIÓN: Introducción: la pandemia originada por el SARS-CoV-2 provocó la declaración del estado de alarma sanitaria entre marzo y junio de 2020 en España. Los bancos de leche materna han visto afectada su actividad durante este periodo, siendo necesario implementar nuevas medidas para promocionar la donación de leche y disminuir el impacto en la actividad. Método y objetivo: el objetivo del estudio es evaluar el impacto del estado de alarma decretado desde el 14 de marzo al 22 de junio de 2020 en el Banco de Leche del Hospital Virgen de las Nieves de Granada, en comparación con el mismo periodo del año previo. Para ello se ha realizado un estudio descriptivo retrospectivo en el que se han tenido en cuenta los indicadores de actividad del Banco de Leche de forma global y se han comparado los datos del Banco de Leche del Hospital Universitario Virgen de las Nieves, ubicado en Granada, con los datos de los centros periféricos que colaboran con el mismo. Resultados: durante el primer estado de alarma de 2020 hubo una disminución global de las inscripciones de nuevas donantes, del número de donantes que donaron leche, del volumen de donación media por madre y del volumen total de leche cruda recibida y pasteurizada. A pesar de ello, en el banco de leche de Granada aumentaron las nuevas inscripciones durante este periodo, así como el número de donantes que donaron leche. Discusión: las medidas adoptadas en el banco de leche ubicado en Granada, como incentivar la donación de leche entre las madres con niños ingresados en la Unidad Neonatal, aumentar la información a las madres y recoger la leche donada a domicilio, permitieron atenuar el impacto de la pandemia, garantizando la seguridad.

Anesthetic Resource Limitations and Adaptations in Times of Shortage: Experiences from New York Presbyterian Hospital During COVID-19.

In March 2020, the COVID-19 pandemic reached New York City, resulting in thousands of deaths over the following months. Because of the exponential spread of disease, the New York City hospital systems became rapidly overwhelmed. The Department of Anesthesiology at New York Presbyterian (NYP)-Columbia continued to offer anesthesia services for obstetrics and emergency surgery, while redirecting the rest of its staff to the expanded airway management role and the creation of the largest novel intensive care unit in the NYP system. Tremendous innovation and optimization were necessary in the face of material, physical, and staffing constraints.

Coronavirus disease 2019: changing the future of emergency epistaxis management.

BACKGROUND: Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. METHODS: A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. RESULTS: A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. CONCLUSION: The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens.

The result of the use of remote consultation in orthopaedic and trauma surgery during the COVID-19 pandemic.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients.The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5619 patients were made with a lack of response of 19%The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department.Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement.Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually.Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests.Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria.El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes.Son objetivos operativos; proponer un plan de consultas, conocer como limita la asistencia a las consultas, definir qué patologías se benefician mas con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5619 consultas con una falta de respuesta telefónica del 19%.El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo mas probable la respuesta telefónica para las consulta de unidad, OR = 0.60 o de traumatología general, OR = 0.67 y menos para los derivados desde urgencias.El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0.34, control postoperatorio, OR = 0.49, y unidades, OR = 0.40, cumplieron mejor este requisito.De los pacientes restantes, las consultas de traumatología general, OR = 0.50, y las derivadas a unidades, OR = 0.54, fueron las que se mas se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que mas precisan de ser realizadas de forma presencial.

[From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants]. / Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.

INTRODUCTION AND AIM: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. MATERIAL AND METHODS: Narrative description of the adopted measures; Online survey among participants. RESULTS: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). CONCLUSIONS: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.

TITLE: Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.Introducción y objetivo. La pandemia de COVID-19 ha trastornado la actividad hospitalaria, incluyendo la docente. Se describe el cambio de un sistema presencial a otro de sesiones en línea en un servicio de neurología, y se analizan la satisfacción y las opiniones de los usuarios. Material y métodos. Exposición de las medidas adoptadas para pasar a modalidad en línea y análisis de una encuesta entre los participantes. Resultados. Se pasó de tres a dos sesiones semanales, con restricción del público presencial. El público virtual superó al presencial. Contestaron la encuesta 49 participantes, un 51% mujeres, con una media de 40,5 años (rango: 25-65). La satisfacción de los asistentes fue mayor para las sesiones presenciales (8,68) que para las en línea (8,12) (p = 0,006). Existía una correlación inversa significativa entre la edad y la satisfacción con las sesiones en línea (r = ­0,37; p = 0,01) que no se daba para las sesiones presenciales. El 75,5% fue partidario de mantener las sesiones virtuales cuando se eliminaran las restricciones de aforo. Una mayoría (87,8%) apoyó sesiones interhospitalarias y recomienda que las autoridades sanitarias faciliten aplicaciones informáticas seguras (53,1%). Conclusiones. La introducción de sesiones virtuales es una medida fácil de implementar en un servicio de neurología, con un alto grado de satisfacción de los usuarios, aunque menor que con las sesiones presenciales. Existen problemas no resueltos respecto al uso de plataformas comerciales y conexión interhospitalaria. Sería recomendable que las autoridades sanitarias y educativas desarrollaran aplicaciones seguras y fomentaran la educación médica en línea.