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1.
Anesth Prog ; 69(1): 59-60, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1775598
2.
AORN J ; 115(4): P10-P13, 2022 04.
Article in English | MEDLINE | ID: covidwho-1772649
3.
J Am Coll Surg ; 234(2): 191-202, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1713819

ABSTRACT

BACKGROUND: Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality. RESULTS: During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use. CONCLUSION: Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.


Subject(s)
COVID-19/epidemiology , General Surgery/statistics & numerical data , Office Visits/statistics & numerical data , Pandemics , Telemedicine/statistics & numerical data , Adult , Aged , Ambulatory Surgical Procedures , Computer Literacy , Female , Health Services Accessibility/statistics & numerical data , Humans , Insurance Coverage/statistics & numerical data , Logistic Models , Male , Massachusetts/epidemiology , Middle Aged , Public Health , Retrospective Studies , Socioeconomic Factors , Telephone/statistics & numerical data
4.
Cir Esp (Engl Ed) ; 100(3): 115-124, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1703329

ABSTRACT

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.


Subject(s)
COVID-19 , Surgeons , Ambulatory Surgical Procedures , Consensus , Humans , Pandemics , SARS-CoV-2
5.
Am J Case Rep ; 23: e934049, 2022 Feb 05.
Article in English | MEDLINE | ID: covidwho-1675225

ABSTRACT

BACKGROUND Liposuction is a one of the most common aesthetic procedures. The super-wet and tumescent techniques are used most frequently. Both serve to reduce collateral blood loss, facilitate the suctioning procedure, and providing local anesthesia. Overall, liposuction is considered safe and effective, with minor adverse effects such as swelling, minute bleeding, contour irregularities, and seroma. Serious complication such as life-threatening bleeding are rare. In this case report, we present a patient with significant postoperative bleeding following minor-to-moderate liposuction performed at a day surgery center. CASE REPORT A 51-year-old healthy man, 4 days after 1600-cc aspirate tumescent liposuction performed in a day surgery center, was admitted to our ward with tachycardia, weakness, abdominal pain and disseminated hematoma. On admission, laboratory testing showed hematocrit of 20.9% and hemoglobin of 6.9 gr/dl. Immediate abdominal CT angiography was performed to exclude active bleeding, showing diffused hematoma in the subcutaneous fat all over the abdomen and scrotum, with some edema without active bleeding. The patient was treated with blood transfusion to facilitate fast home discharge during the peak of the COVID-19 epidemic that time. CONCLUSIONS We discuss the common work-up and treatment of postoperative hemorrhage. Blood transfusion following minor-to-moderate liposuction is unusual but during the COVID-19 pandemic it can facilitate quick discharge of a patient with postoperative hemorrhage with no active bleeding. Improper patient selection, an inexperienced surgeon, and inadequate operating locale can all result in postoperative complications. We call for the formulation of more detailed guidelines for liposuction setting.


Subject(s)
COVID-19 , Lipectomy , Abdomen , Ambulatory Surgical Procedures , Humans , Lipectomy/adverse effects , Male , Middle Aged , Pandemics , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/therapy , SARS-CoV-2
6.
Dermatol Surg ; 47(7): 931-933, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1517923

ABSTRACT

BACKGROUND: The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery. OBJECTIVE: Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand. MATERIALS AND METHODS: United States national and state-based Google search data for "Mohs surgery" and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends. RESULTS: Search volume for "Mohs surgery" and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between "Mohs surgery" search volume and new COVID-19 deaths on a national and state-based level. CONCLUSION: Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.


Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Attitude to Health , COVID-19/epidemiology , Cosmetic Techniques/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Mohs Surgery/statistics & numerical data , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , United States/epidemiology
7.
Am Surg ; 88(3): 489-497, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1506800

ABSTRACT

OBJECTIVES: COVID-19 has caused significant surgical delays as institutions minimize patient exposure to hospital settings and utilization of health care resources. We aimed to assess changes in surgical case mix and outcomes due to restructuring during the pandemic. METHODS: Patients undergoing surgery at a single tertiary care institution in the Deep South were identified using institutional ACS-NSQIP data. Primary outcome was case mix. Secondary outcomes were post-operative complications. Chi-square, ANOVA, logistic regression, and linear regression were used to compare the control (pre-COVID, Mar 2018-Mar 2020) and case (during COVID, Mar 2020-Mar 2021) groups. RESULTS: Overall, there were 6912 patients (control: 4,800 and case: 2112). Patients were 70% white, 29% black, 60% female, and 39% privately insured. Mean BMI was 30.2 (SD = 7.7) with mean age of 58.3 years (SD = 14.8). Most surgeries were with general surgery (48%), inpatient (68%), and elective (83%). On multivariable logistic regression, patients undergoing surgery during the pandemic were more likely to be male (OR: 1.14) and in SIRS (OR: 2.07) or sepsis (OR: 2.28) at the time of surgery. Patients were less likely to have dyspnea with moderate exertion (OR: .75) and were less dependent on others (partially dependent OR: .49 and totally dependent OR: .15). Surgeries were more likely to be outpatient (OR: 1.15) and with neurosurgery (OR: 1.19). On bivariate analysis, there were no differences in post-operative outcomes. CONCLUSION: Surgeries during the COVID-19 pandemic were more often outpatient without differences in post-operative outcomes. Additional analysis is needed to determine the impact of duration of operative delay on surgical outcomes with restructuring focusing more on outpatient surgeries.


Subject(s)
COVID-19/epidemiology , Diagnosis-Related Groups , Pandemics , Surgical Procedures, Operative/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Alabama , Ambulatory Surgical Procedures/statistics & numerical data , Case-Control Studies , Elective Surgical Procedures/statistics & numerical data , Female , General Surgery/statistics & numerical data , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Regression Analysis , Tertiary Care Centers , Treatment Outcome , Young Adult
9.
Thorac Cancer ; 12(21): 2865-2872, 2021 11.
Article in English | MEDLINE | ID: covidwho-1494370

ABSTRACT

BACKGROUND: Lung cancer, the leading cause of cancer-related deaths worldwide, has high morbidity rates. Video-assisted thoracoscopic surgery (VATS) as day surgery makes surgical treatment ideally in time with the same quality of medical care. This study aimed to assess the safety of stage I NSCLC patients who underwent VATS at a day surgery center. METHODS: We retrospectively analyzed the clinical characteristics and tumor features of VATS patients at a single center, West China Hospital, from June 1, 2019, to December 31, 2020. Patients fulfilled all inclusion criteria, did not meet any exclusion criteria and underwent wedge resection, segmentectomy, or lobectomy with systematic lymph node dissection. RESULTS: The median patient age was 43 (range, 19-67) years. Of the 209 patients, most were women. A total of 108 (51.7%) patients underwent segmentectomy, 87 (41.6%) lobectomy, and 14 (6.7%) wedge resection with systematic lymph node dissection. According to the AJCC/UICC eighth edition of lung cancer stage grouping, stages IA, IA1, IA2, and IA3 were 195 (93.3%), 122 (58.4%), 50 (23.9%), and one (0.5%), respectively. A total of 36 (17.2%) patients were stage 0. Adenocarcinoma was predominantly the postoperative pathological diagnosis, as only 14 (6.7%) were benign. A total of 201 (96.17%) patients were discharged without a chest tube. The most common chief complaints were cough, incisional pain, and shortness of breath. No severe complications or life-threatening emergencies were observed. CONCLUSIONS: The day surgery mode of VATS for stage I NSCLC is safe and feasible, which makes surgical treatment ideally in time for stage I NSCLC patients with the same quality of medical care.


Subject(s)
Ambulatory Surgical Procedures/methods , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/secondary , Thoracic Surgery, Video-Assisted/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
10.
J Plast Reconstr Aesthet Surg ; 74(11): 3178-3185, 2021 11.
Article in English | MEDLINE | ID: covidwho-1491753

ABSTRACT

The novel coronavirus outbreak (COVID-19) in 2019 resulted in the suspension of all elective hospital procedures during the height of the pandemic in the UK. The Clinic in London is one of the first day-case hospitals to resume cosmetic surgery in a post-COVID-19 clinical environment, whilst also employing the use of virtual consultations. Details of the protocol implemented by the Clinic to allow the safe resumption of cosmetic surgery are stated in this paper. The volume of procedures at the Clinic saw a significant increase post-lockdown; reasons as to why this occurred are also explored in this paper. The disruption of cosmetic practice during lockdown can be said to have resulted in a backlog of procedures once lockdown restrictions began to ease. Whilst this may be true, we believe that there are other confounding factors regarding what may have influenced the rise in cosmetic surgery during the pandemic, including the privacy of working from home and the increased exposure to video conferencing software.


Subject(s)
Ambulatory Surgical Procedures , COVID-19 , Pandemics , Reconstructive Surgical Procedures , Ambulatory Surgical Procedures/statistics & numerical data , Cohort Studies , Hospitals , Humans , Infection Control , London/epidemiology , Patient Selection , Reconstructive Surgical Procedures/statistics & numerical data , Remote Consultation , Retrospective Studies
12.
Ann R Coll Surg Engl ; 104(3): 165-173, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1331976

ABSTRACT

INTRODUCTION: We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature. METHODS: An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA. FINDINGS: Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%. CONCLUSION: We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.


Subject(s)
Ambulatory Surgical Procedures , Arthroplasty, Replacement, Knee , Aged , Ambulatory Surgical Procedures/adverse effects , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures/statistics & numerical data , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Arthroplasty, Replacement, Knee/statistics & numerical data , COVID-19 , Humans , Middle Aged , Patient Discharge/statistics & numerical data , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology
16.
Ann R Coll Surg Engl ; 103(7): 496-498, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288680

ABSTRACT

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.


Subject(s)
Ambulatory Surgical Procedures/trends , COVID-19/prevention & control , Otorhinolaryngologic Surgical Procedures/trends , Patient Admission/trends , Surgery Department, Hospital/trends , Ambulatory Surgical Procedures/standards , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Epistaxis/surgery , Humans , Infection Control/standards , Northern Ireland/epidemiology , Otorhinolaryngologic Surgical Procedures/standards , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Pandemics/prevention & control , Patient Admission/standards , Patient Admission/statistics & numerical data , Peritonsillar Abscess/surgery , Retrospective Studies , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
17.
Ann R Coll Surg Engl ; 103(7): 478-480, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288679

ABSTRACT

BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.


Subject(s)
Ambulatory Surgical Procedures/mortality , COVID-19/epidemiology , Elective Surgical Procedures/mortality , Emergency Treatment/mortality , Ambulatory Surgical Procedures/standards , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/complications , COVID-19/diagnosis , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/standards , Emergency Treatment/statistics & numerical data , England/epidemiology , Female , Hospital Mortality , Humans , Incidence , Infection Control/standards , Infection Control/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Pandemics/prevention & control , Pandemics/statistics & numerical data , Patient Admission/standards , Patient Admission/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , State Medicine/standards , State Medicine/statistics & numerical data
18.
Ann R Coll Surg Engl ; 103(7): 487-492, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288676

ABSTRACT

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Emergency Treatment/statistics & numerical data , General Surgery/organization & administration , Surgery Department, Hospital/organization & administration , Adult , Aged , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Conservative Treatment/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/methods , Emergency Treatment/standards , Female , Follow-Up Studies , General Surgery/standards , General Surgery/statistics & numerical data , Hospital Mortality , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Middle Aged , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Patient Safety/standards , Prospective Studies , Referral and Consultation/organization & administration , Referral and Consultation/standards , Referral and Consultation/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
19.
J Gynecol Obstet Hum Reprod ; 50(9): 102166, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1240456

ABSTRACT

OBJECTIVE: This study examined the impact of lockdown for SARS-CoV-2 on breast cancer management via an online survey in a French multicentre setting. MATERIAL AND METHODS: This is a multicentre retrospective study, over the strict lockdown period from March 16th to May 11th, 2020 in metropolitan France. 20 centres were solicited, of which 12 responded to the survey. RESULTS: 50% of the centres increased their surgical activity, 33% decreased it and 17% did not change it during containment. Some centres had to cancel (17%) or postpone (33%) patient-requested interventions due to fear of SARS-CoV-2. Four and 6 centres (33% and 50%) respectively cancelled and postponed interventions for medical reasons. In the usual period, 83% of the centres perform their conservative surgeries on an outpatient basis, otherwise the length of hospital stay was 24 to 48 h. All the centres except one performed conservative surgery on an outpatient basis during the lockdown period, for which. 8% performed mastectomies on an outpatient basis during the usual period. During lockdown, 50% of the centres reduced their hospitalization duration (25% outpatient /25% early discharge on Day 1). CONCLUSION: This study explored possibilities for management during the first pandemic lockdown. The COVID-19 pandemic required a total reorganization of the healthcare system, including the care pathways for cancer patients.


Subject(s)
Breast Neoplasms/surgery , Breast Neoplasms/therapy , COVID-19/prevention & control , SARS-CoV-2 , Surgical Procedures, Operative/statistics & numerical data , Ambulatory Surgical Procedures/statistics & numerical data , Conservative Treatment/statistics & numerical data , Female , France , Humans , Length of Stay , Mammaplasty/statistics & numerical data , Mastectomy/statistics & numerical data , Patient Isolation/methods , Retrospective Studies , Surveys and Questionnaires
20.
Ann R Coll Surg Engl ; 103(6): 390-394, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1223791

ABSTRACT

The COVID-19 pandemic is the most serious health crisis of our time. Global public measures have been enacted to try to prevent healthcare systems from being overwhelmed. The trauma and orthopaedic (T&O) community has overcome challenges in order to continue to deliver acute trauma care to patients and plan for challenges ahead. This review explores the lessons learnt, the priorities and the controversies that the T&O community has faced during the crisis. Historically, the experience of major incidents in T&O has focused on mass casualty events. The current pandemic requires a different approach to resource management in order to create a long-term, system-sustaining model of care alongside a move towards resource balancing and facilitation. Significant limitations in theatre access, anaesthetists and bed capacity have necessitated adaptation. Strategic changes to trauma networks and risk mitigation allowed for ongoing surgical treatment of trauma. Outpatient care was reformed with the uptake of technology. The return to elective surgery requires careful planning, restructuring of elective pathways and risk management. Despite the hope that mass vaccination will lift the pressure on bed capacity and on bleak economic forecasts, the orthopaedic community must readjust its focus to meet the challenge of huge backlogs in elective caseloads before looking to the future with a robust strategy of integrated resilient pathways. The pandemic will provide the impetus for research that defines essential interventions and facilitates the implementation of strategies to overcome current barriers and to prepare for future crises.


Subject(s)
COVID-19/epidemiology , Health Priorities , Orthopedic Procedures , Wounds and Injuries/surgery , Ambulatory Surgical Procedures , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Health Priorities/organization & administration , Health Priorities/standards , Humans , Orthopedic Procedures/statistics & numerical data , Traumatology/organization & administration , Traumatology/standards
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