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1.
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
3.
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
4.
Ann R Coll Surg Engl ; 103(3): 173-179, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1073075

ABSTRACT

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.


Subject(s)
Elective Surgical Procedures/methods , Neoplasms/surgery , Surgical Procedures, Operative/methods , Time-to-Treatment , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Surgical Procedures/methods , Arteriovenous Shunt, Surgical , COVID-19 , COVID-19 Nucleic Acid Testing , Cardiac Catheterization , Delivery of Health Care/organization & administration , Female , Hospitalization/statistics & numerical data , Humans , Hysterectomy , Male , Mass Screening , Middle Aged , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , SARS-CoV-2 , United Kingdom/epidemiology , Urologic Surgical Procedures , Young Adult
5.
Qual Manag Health Care ; 30(1): 69-73, 2021.
Article in English | MEDLINE | ID: covidwho-915952

ABSTRACT

BACKGROUND AND OBJECTIVES: With the resumption of elective ophthalmic surgery during COVID-19, revised protocols were mandated to protect both staff and patients from transmission while increasing case numbers. We discuss a widely generalizable and in-depth protocol intended to safely allow the restart of elective procedures in 2 dedicated ophthalmic ambulatory surgical centers (ASCs) using monitored anesthesia care. METHODS: A single-center review of protocols and practices designed to limit COVID-19 transmission. RESULTS: All patients were tested within 72 hours prior to the procedure with a COVID-19 nasal swab to assess for active disease. A distance of 6 ft between each stretcher and the staff within the ASC was maintained when possible. Preoperative anesthetizing and dilating eye drops were administered from multiuse bottles without contact with surfaces. Surgical cases were restarted at a reduced capacity of a maximum of 7 per day to distance patient arrivals. Removal of waiting room chairs and the creation of new break areas allowed for social distancing. CONCLUSION: As recommendations change on the basis of an increased understanding of the COVID-19 virus, ophthalmologists and ASC staff need to tailor protocols and workflows to limit transmission of virus with resumption of ocular surgery.


Subject(s)
Ambulatory Surgical Procedures/methods , COVID-19/prevention & control , Clinical Protocols , Cross Infection/prevention & control , Ophthalmologic Surgical Procedures/methods , Anesthesia/methods , COVID-19/epidemiology , Communication , Humans , Ophthalmic Solutions/administration & dosage , Physical Distancing , Postoperative Care/methods , Preoperative Care/methods
6.
Brachytherapy ; 20(1): 284-289, 2021.
Article in English | MEDLINE | ID: covidwho-695371

ABSTRACT

PURPOSE: The COVID-19 pandemic presents serious challenges for brachytherapists, and in the time-sensitive case of locally advanced cervical cancer, the need for curative brachytherapy (BT) is critical for survival. Given the high-volume of locally advanced cervical cancer in our safety-net hospital, we developed a strategy in close collaboration with our gynecology oncology and anesthesia colleagues to allow for completely clinic-based intracavitary brachytherapy (ICBT). METHODS AND MATERIALS: This technical report will highlight our experience with the use of paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for appropriately selected cervical ICBT cases, allowing for completely clinic-based treatment. RESULTS: 18 of 19 (95%) screened patients were eligible for in-clinic ICBT. The excluded patient had significant vaginal fibrosis. 38 of 39 intracavitary implants were successfully transitioned for entirely in-clinic treatment utilizing PCBs and oral MMA (97% success rate). One case was aborted due to inadequate analgesia secondary to a significantly delayed case start time (PO medication effect diminished). 95% of patients reported no pain at the conclusion of the procedure. The median (IQR) D2cc for rectum and bladder were 64.8 (58.6-70.2) Gy and 84.1 (70.9-89.4) Gy, respectively. Median (IQR) CTV high-risk D90 was 88.0 (85.6-89.8) Gy. CONCLUSIONS: In a multidisciplinary effort, we have successfully transitioned many ICBT cases to the clinic with the use of PCB local anesthesia and oral multimodality therapy in direct response to the current pandemic, thereby mitigating exposure risk to patients and staff as well as reducing overall health care burden.


Subject(s)
Ambulatory Surgical Procedures/methods , Analgesics/therapeutic use , Anesthesia, Local/methods , Anesthesia, Obstetrical/methods , Brachytherapy/methods , Pain, Procedural/prevention & control , Uterine Cervical Neoplasms/radiotherapy , Anti-Anxiety Agents/therapeutic use , Antiemetics/therapeutic use , COVID-19 , Female , Gabapentin/therapeutic use , Humans , Hydromorphone/therapeutic use , Ibuprofen/therapeutic use , Lorazepam/therapeutic use , Organs at Risk , Pain, Procedural/drug therapy , Pandemics , Promethazine/therapeutic use , Radiotherapy Dosage , Rectum , SARS-CoV-2 , Urinary Bladder , Uterine Cervical Neoplasms/pathology
9.
Int Urol Nephrol ; 52(11): 2059-2064, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-613477

ABSTRACT

PURPOSE: It is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed. METHODS: Urological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported. RESULTS: Of the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period. CONCLUSION: In the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure.


Subject(s)
Ambulatory Care , Ambulatory Surgical Procedures , Coronavirus Infections , Infection Control , Pandemics , Pneumonia, Viral , Urologic Diseases , Urologic Surgical Procedures , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , Ambulatory Surgical Procedures/methods , Betacoronavirus , COVID-19 , Change Management , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Emergency Treatment/methods , Emergency Treatment/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Minimally Invasive Surgical Procedures/statistics & numerical data , Outcome and Process Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Turkey/epidemiology , Urologic Diseases/epidemiology , Urologic Diseases/surgery , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data
10.
Breast Cancer Res Treat ; 182(3): 679-688, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-608129

ABSTRACT

PURPOSE: As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. METHODS: IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. RESULTS: Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. CONCLUSION: This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.


Subject(s)
Ambulatory Surgical Procedures/methods , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Mammaplasty/methods , Mastectomy/methods , Quality Improvement , Adult , Aftercare , Anesthesiology , Betacoronavirus , Breast Implantation , Breast Implants , COVID-19 , Clinical Protocols , Coronavirus Infections/epidemiology , Efficiency , Emergency Service, Hospital , Female , Health Resources , Home Care Services , Humans , Length of Stay , Middle Aged , Pandemics , Patient Readmission , Perioperative Care/methods , Pneumonia, Viral/epidemiology , Prospective Studies , SARS-CoV-2 , Sentinel Lymph Node Biopsy , Surgery, Plastic , Surgical Oncology , Telemedicine , Tissue Expansion Devices
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