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2.
Ann Surg ; 272(2): e98-e105, 2020 08.
Article in English | MEDLINE | ID: covidwho-706523

ABSTRACT

OBJECTIVE: The COVID-19 pandemic requires to conscientiously weigh "timely surgical intervention" for colorectal cancer against efforts to conserve hospital resources and protect patients and health care providers. SUMMARY BACKGROUND DATA: Professional societies provided ad-hoc guidance at the outset of the COVID-19 pandemic on deferral of surgical and perioperative interventions, but these lack specific parameters to determine the optimal timing of surgery. METHODS: Using the GRADE system, published evidence was analyzed to generate weighted statements for stage, site, acuity of presentation, and hospital setting to specify when surgery should be pursued, the time and duration of oncologically acceptable delays, and when to utilize nonsurgical modalities to bridge the waiting period. RESULTS: Colorectal cancer surgeries-prioritized as emergency, urgent with imminent emergency or oncologically urgent, or elective-were matched against the phases of the pandemic. Surgery in COVID-19-positive patients must be avoided. Emergent and imminent emergent cases should mostly proceed unless resources are exhausted. Standard practices allow for postponement of elective cases and deferral to nonsurgical modalities of stage II/III rectal and metastatic colorectal cancer. Oncologically urgent cases may be delayed for 6(-12) weeks without jeopardizing oncological outcomes. Outside established principles, administration of nonsurgical modalities is not justified and increases the vulnerability of patients. CONCLUSIONS: The COVID-19 pandemic has stressed already limited health care resources and forced rationing, triage, and prioritization of care in general, specifically of surgical interventions. Established guidelines allow for modifications of optimal timing and type of surgery for colorectal cancer during an unrelated pandemic.


Subject(s)
Colorectal Neoplasms/surgery , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Betacoronavirus , Decision Making , Digestive System Surgical Procedures , Elective Surgical Procedures , Health Care Rationing , Health Priorities , Humans , Pandemics , Patient Selection , Practice Guidelines as Topic , Triage , Waiting Lists
5.
Int J Surg ; 80: 194-201, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-654526

ABSTRACT

BACKGROUND: After the emergence of Covid-19 in China, Hubei Province, the epidemic quickly spread to Europe. France was quickly hit and our institution was one of the first French university to receive patients infected with Sars-COV2. The predicted massive influx of patients motivated the cancellation of all elective surgical procedures planned to free hospitalization beds and to free intensive care beds. Nevertheless, we should properly select patients who will be canceled to avoid life-threatening. The retained surgical indications are surgical emergencies, oncologic surgery, and organ transplantation. MATERIAL AND METHODS: We describe the organization of our institution which allows the continuation of these surgical activities while limiting the exposure of our patients to the Sars Cov2. RESULTS: After 4 weeks of implementation of intra-hospital protocols for the control of the Covid-19 epidemic, 112 patients were operated on (104 oncology or emergency surgeries and 8 liver transplants). Only one case of post-operative contamination was observed. No mortality related to Covid-19 was noted. No cases of contamination of surgical care personnel have been reported. CONCLUSION: We found that the performance of oncological or emergency surgery is possible, safe for both patients and caregivers.


Subject(s)
Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative/methods , Adult , Aged , Aged, 80 and over , Betacoronavirus , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Digestive System Surgical Procedures , Elective Surgical Procedures/methods , Emergencies , Female , France/epidemiology , Gynecologic Surgical Procedures , Health Facilities , Humans , Liver Transplantation/methods , Lung/diagnostic imaging , Male , Mass Screening , Middle Aged , Otorhinolaryngologic Surgical Procedures , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Quality Improvement , Real-Time Polymerase Chain Reaction , Retrospective Studies , Tertiary Care Centers , Tomography, X-Ray Computed
6.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-646934

ABSTRACT

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Subject(s)
Coronavirus Infections/epidemiology , Digestive System Surgical Procedures , Emergencies , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Respiratory Insufficiency/epidemiology , Respiratory Tract Infections/epidemiology , Abscess/surgery , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy , Betacoronavirus , Cholecystectomy, Laparoscopic , Comorbidity , Coronavirus Infections/therapy , Disease Outbreaks , Drainage , Female , Herniorrhaphy , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Embolism/drug therapy , Pulmonary Embolism/epidemiology , Respiratory Insufficiency/therapy , Respiratory Tract Infections/therapy , Retrospective Studies , Surgical Wound Infection/drug therapy , Surgical Wound Infection/epidemiology , United Kingdom/epidemiology , Young Adult
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 616-618, 2020 Jun 25.
Article in Chinese | MEDLINE | ID: covidwho-593596

ABSTRACT

In hospitals and medical schools as densely populated sites with high risk of coronavirus disease 2019 (COVID-19), it is vital to adjust the teaching and training strategy for medical students to ensure curriculum completion with safety. This article aims to introduce the experience of teaching and training for medical students under the epidemic situation at Department of Surgery, Shanghai Medical College, Fudan University and Zhongshan Hospital. The content includes exploring diversified online teaching models for undergraduate surgery courses and clinical practice, carrying out online graduate education and dissertation plans, and strengthening comprehensive education of medical humanity combined with knowledge of COVID-19 prevention. Through implementation of the above teaching strategies, scheduled learning plans of medical students can be well completed in an orderly, safe and quality-ensured manner. Our experience provides practical solution of medical teaching and could be advisable for other medical colleges and teaching hospitals.


Subject(s)
Coronavirus Infections/epidemiology , Digestive System Surgical Procedures/education , Education, Distance/standards , Education, Medical, Undergraduate/standards , Pandemics , Pneumonia, Viral/epidemiology , Specialties, Surgical/standards , Betacoronavirus , China/epidemiology , Coronavirus Infections/prevention & control , Digestive System Surgical Procedures/standards , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control
9.
HPB (Oxford) ; 22(8): 1128-1134, 2020 08.
Article in English | MEDLINE | ID: covidwho-592305

ABSTRACT

BACKGROUND: The extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery. METHODS: An online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects of service delivery. RESULTS: Overall, 145 (25%) members responded. Most units, particularly in COVID-high countries (>100,000 cases) reported insufficient critical care capacity and reduced HPB operating sessions compared to COVID-low countries. Delayed access to cancer surgery necessitated alternatives including increased neoadjuvant chemotherapy for pancreatic cancer and colorectal liver metastases, and locoregional treatments for hepatocellular carcinoma. Other aspects of service delivery including COVID-19 screening and personal protective equipment varied between units and countries. CONCLUSION: This study demonstrates that the COVID-19 pandemic has had a profound adverse impact on the delivery of HPB cancer care across the continents of Europe and Africa. The findings illustrate the need for safe resumption of cancer surgery in a "new" normal world with screening of patients and staff for COVID-19.


Subject(s)
Betacoronavirus , Biliary Tract Neoplasms/surgery , Coronavirus Infections/complications , Digestive System Surgical Procedures/methods , Liver Neoplasms/surgery , Pancreatic Neoplasms/surgery , Pneumonia, Viral/complications , Africa/epidemiology , Biliary Tract Neoplasms/complications , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Delivery of Health Care/methods , Europe/epidemiology , Female , Humans , Liver Neoplasms/complications , Male , Pancreatic Neoplasms/complications , Pandemics , Pneumonia, Viral/epidemiology , Societies, Medical
14.
Eur Rev Med Pharmacol Sci ; 24(9): 5162-5166, 2020 05.
Article in English | MEDLINE | ID: covidwho-339621

ABSTRACT

OBJECTIVE: Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency. PATIENTS AND METHODS: In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. RESULTS: None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed. CONCLUSIONS: Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity.


Subject(s)
Anesthesia, Local/methods , Coronavirus Infections , Digestive System Surgical Procedures/methods , Laparotomy , Pandemics , Pneumonia, Viral , Wakefulness , Aged, 80 and over , Anesthesia, Epidural/methods , Anesthesia, Spinal/methods , Betacoronavirus , Female , Humans , Male , Operative Time , Pain, Postoperative/therapy , Pain, Procedural/therapy
15.
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
17.
Dig Liver Dis ; 52(6): 597-603, 2020 06.
Article in English | MEDLINE | ID: covidwho-295511

ABSTRACT

INTRODUCTION: Patients treated for malignancy are considered at risk of severe COVID-19. This exceptional pandemic has affected countries on every level, particularly health systems which are experiencing saturation. Like many countries, France is currently greatly exposed, and a complete reorganization of hospitals is ongoing. We propose here adaptations of diagnostic procedures, therapies and care strategies for patients treated for digestive cancer during the COVID-19 epidemic. METHODS: French societies of gastroenterology and gastrointestinal (GI) oncology carried out this study to answer two main questions that have arisen (i) how can we limit high-risk situations for GI-cancer patients and (ii) how can we limit contact between patients and care centers to decrease patients' risk of contamination while continuing to treat their cancer. All recommendations are graded as experts' agreement according to the level of evidence found in the literature until March 2020. RESULTS: A proposal to adapt treatment strategies was made for the main GI oncology situations. Considering the level of evidence and the heterogeneous progression of the COVID-19 epidemic, all proposals need to be considered by a multidisciplinary team and implemented with patient consent. CONCLUSION: COVID-19 epidemic may significantly affect patients treated for digestive malignancies. Healthcare teams need to consider adapting treatment sequences when feasible and according to the epidemic situation.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Gastrointestinal Neoplasms , Infection Control , Pandemics , Patient Care Management , Pneumonia, Viral , Antineoplastic Agents/therapeutic use , Betacoronavirus/isolation & purification , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Digestive System Surgical Procedures/methods , France/epidemiology , Gastrointestinal Neoplasms/epidemiology , Gastrointestinal Neoplasms/therapy , Humans , Infection Control/methods , Infection Control/organization & administration , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Societies, Medical
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