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1.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1062940

ABSTRACT

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Subject(s)
Digestive System Diseases , Digestive System Surgical Procedures , Emergency Treatment , Infection Control , Postoperative Complications , Time-to-Treatment , Adult , /prevention & control , Digestive System Diseases/diagnosis , Digestive System Diseases/epidemiology , Digestive System Diseases/mortality , Digestive System Diseases/surgery , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/mortality , Emergencies/epidemiology , Emergency Treatment/adverse effects , Emergency Treatment/methods , Emergency Treatment/mortality , Female , Humans , Incidence , Infection Control/methods , Infection Control/statistics & numerical data , Male , Mortality , Multicenter Studies as Topic , Observational Studies as Topic , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Research Design , Risk Assessment/methods
3.
Clin Res Hepatol Gastroenterol ; 44(4): 403-406, 2020 09.
Article in English | MEDLINE | ID: covidwho-597127

ABSTRACT

2019 novel coronavirus pneumonia is a serious life-threatening disease and it has affected many people globally, especially the people who live in China. A high prevalence of hepatobiliary diseases has been observed in 2019-nCoV patients and some may require emergency surgery. In the context of the novel coronavirus pneumonia, new challenges have arisen for surgeons in terms of ways to effectively treat outpatients, safety of medical staffs in performing surgery treatment, and the lack of efficient postoperative management and follow-up procedure. It is hoped that through this article, surgeons will have a better system in hepatobiliary diseases classification, treatment selection, and protective measures to improve the clinical practice in accordance with the guidelines for the diagnosis and treatment of the novel coronavirus pneumonia.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Digestive System Diseases/diagnosis , Digestive System Diseases/surgery , Pandemics , Pneumonia, Viral/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Elective Surgical Procedures , Humans , Lactones , Pandemics/prevention & control , Patient Selection , Perioperative Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Postoperative Care , Sesquiterpenes , Telemedicine , Triage
7.
Clin Gastroenterol Hepatol ; 18(10): 2287-2294.e1, 2020 09.
Article in English | MEDLINE | ID: covidwho-327107

ABSTRACT

BACKGROUND & AIMS: Practices dramatically reduced endoscopy services due to the COVID-19 pandemic. Because practices now are considering reintroduction of elective endoscopy, we conducted a survey of North American practices to identify reactivation barriers and strategies. METHODS: We designed and electronically distributed a web-based survey to North American gastroenterologists consisting of 7 domains: institutional demographics, impact of COVID-19 on endoscopy practice, elective endoscopy resumption plans, anesthesia modifications, personal protective equipment policies, fellowship training, and telemedicine use. Responses were stratified by practice type: ambulatory surgery center (ASC) or hospital-based. RESULTS: In total, 123 practices (55% ASC-based and 45% hospital-based) responded. At the pandemic's peak (as reported by the respondents), practices saw a 90% decrease in endoscopy volume, with most centers planning to resume elective endoscopy a median of 55 days after initial restrictions. Declining community prevalence of COVID-19, personal protective equipment availability, and preprocedure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing availability were ranked as the 3 primary factors influencing reactivation timing. ASC-based practices were more likely to identify preprocedure testing availability as a major factor limiting elective endoscopy resumption (P = .001). Preprocedure SARS-CoV-2 testing was planned by only 49.2% of practices overall; when testing is performed and negative, 52.9% of practices will continue to use N95 masks. CONCLUSIONS: This survey highlights barriers and variable strategies for reactivation of elective endoscopy services after the COVID-19 pandemic. Our results suggest that more widespread access to preprocedure SARS-CoV-2 tests with superior performance characteristics is needed to increase provider and patient comfort in proceeding with elective endoscopy.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Digestive System Diseases/surgery , Disease Transmission, Infectious/prevention & control , Gastroenterology/methods , Pandemics , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/transmission , Cross-Sectional Studies , Digestive System Diseases/complications , Digestive System Surgical Procedures , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Surveys and Questionnaires , United States/epidemiology
9.
J Visc Surg ; 157(3S1): S7-S12, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-39755

ABSTRACT

The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.


Subject(s)
Coronavirus Infections , Digestive System Diseases/surgery , Digestive System Neoplasms/surgery , Pandemics , Pneumonia, Viral , Health Services Needs and Demand , Humans , Laparoscopy , Postoperative Care , Practice Guidelines as Topic , Time-to-Treatment
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