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1.
Cochrane Database Syst Rev ; 8: CD010168, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1813437

ABSTRACT

BACKGROUND: This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES: To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. MAIN RESULTS: Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS: The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.


Subject(s)
Abscess/prevention & control , Appendectomy/adverse effects , Appendicitis/surgery , Drainage/methods , Peritonitis/prevention & control , Postoperative Complications/prevention & control , Humans
2.
Interact Cardiovasc Thorac Surg ; 31(1): 42-47, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-1455304

ABSTRACT

OBJECTIVES: The use of digital chest drainage units (CDUs) has become increasingly common in thoracic surgery due to several advantages. However, in cardiac surgery, its use is still limited in favour of conventional analogue CDUs. In order to investigate the potential benefit of digital CDUs in cardiac surgery, we compared the safety and efficacy of both systems in patients undergoing cardiac surgery at our centre. METHODS: We retrospectively investigated 265 consecutive patients who underwent cardiac surgery at our institution between June 2017 and October 2017. These patients were divided into 2 groups: patients with analogue (A, n = 65) and digital CDUs (D, n = 200). Postoperative outcome was analysed and compared between both groups. In addition, the 'user experience' was evaluated by means of a questionnaire. RESULTS: The median age of the cohort was 70 years (P = 0.167), 25.3% of patients were female (P = 0.414). There were no differences in terms of re-explorative surgery or use of blood products. Nor was there a difference in the overall amount of fluid collected. However, during the first 6 h, more fluid was collected by the digital CDUs. The overall rate of technical failure was 0.4%. We observed a significantly higher rate of clotting in the tubing system of the digital CDUs (P = 0.042). Concerning the user experience, the digital CDUs were associated with a more favourable ease of use on the regular wards (P < 0.001). With regard to the overall user experience, the digital CDUs outperformed the analogue systems (P = 0.002). CONCLUSIONS: Digital CDUs can be safely and effectively applied in patients after cardiac surgery. Due to the improved patient mobility and simplified chest tube management, the use of digital CDUs may be advantageous for patients after cardiac surgery. However, the issue of clotting of the tubing systems should be addressed by further technical improvements.


Subject(s)
Cardiac Surgical Procedures/methods , Chest Tubes , Drainage/methods , Postoperative Care/methods , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires
3.
Laryngoscope ; 131(11): 2471-2477, 2021 11.
Article in English | MEDLINE | ID: covidwho-1179005

ABSTRACT

OBJECTIVES/HYPOTHESIS: The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. METHODS: The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. RESULTS: One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. CONCLUSIONS: The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2471-2477, 2021.


Subject(s)
Device Removal/adverse effects , Drainage/instrumentation , Home Care Services/statistics & numerical data , Neck Dissection/methods , Patient Discharge/standards , Postoperative Care/instrumentation , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Device Removal/economics , Drainage/methods , Efficiency , Emergency Service, Hospital/statistics & numerical data , Female , Hematoma/epidemiology , Hematoma/etiology , Home Care Services/trends , Humans , Infections/epidemiology , Infections/etiology , Male , Middle Aged , Neck Dissection/statistics & numerical data , Patient Education as Topic/standards , Patient Education as Topic/trends , Postoperative Care/statistics & numerical data , Prospective Studies , SARS-CoV-2/genetics , Safety , Seroma/epidemiology , Seroma/etiology , Time Factors
4.
Eur J Trauma Emerg Surg ; 47(3): 683-692, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1141395

ABSTRACT

PURPOSE: To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. METHODS: Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. RESULTS: Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4-21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33-157.81), conservative treatment failure (OR 8.2, CI 95% 1.34-50.49) and AC severity were associated with an increased odd of mortality. CONCLUSION: In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.


Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19 , Cholecystectomy/statistics & numerical data , Cholecystitis, Acute , Conservative Treatment , Cross Infection , Infection Control , COVID-19/diagnosis , COVID-19/mortality , COVID-19/prevention & control , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/therapy , Cohort Studies , Comorbidity , Conservative Treatment/methods , Conservative Treatment/statistics & numerical data , Cross Infection/epidemiology , Cross Infection/virology , Drainage/methods , Drainage/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Risk Assessment , SARS-CoV-2 , Spain/epidemiology
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-999234

ABSTRACT

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.


Subject(s)
COVID-19 , Drainage , Mediastinitis , Patient Care Management/methods , Postoperative Complications , Retropharyngeal Abscess , Thoracic Surgical Procedures/methods , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/therapy , Catastrophic Illness/therapy , Diagnosis, Differential , Drainage/adverse effects , Drainage/methods , Humans , Infection Control/methods , Male , Mediastinitis/diagnosis , Mediastinitis/etiology , Mediastinitis/physiopathology , Mediastinitis/surgery , Middle Aged , Neck/diagnostic imaging , Neck/surgery , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/physiopathology , Retropharyngeal Abscess/surgery , SARS-CoV-2 , Treatment Outcome
8.
Interact Cardiovasc Thorac Surg ; 32(3): 367-370, 2021 04 08.
Article in English | MEDLINE | ID: covidwho-939568

ABSTRACT

We report the first surgical series of patients developing pleural empyema after severe bilateral interstitial lung disease in confirmed severe acute respiratory syndrome coronavirus 2 infection. The empyema results in a complex medical challenge that requires combination of medical therapies, mechanical ventilation and surgery. The chest drainage approach was not successful to relieve the symptomatology and to drain the excess fluid. After multidisciplinary discussion, a surgical approach was recommended. Even though decortication and pleurectomy are high-risk procedures, they must be considered as an option for pleural effusion in Coronavirus disease-positive patients. This is a life-treating condition, which can worsen the coronavirus disease manifestation and should be treated immediately to improve patient's status and chance of recovery.


Subject(s)
COVID-19/therapy , Drainage/methods , Empyema, Pleural/surgery , Respiration, Artificial/adverse effects , Aged , COVID-19/epidemiology , Chest Tubes , Empyema, Pleural/epidemiology , Empyema, Pleural/etiology , Humans , Male , Middle Aged , Switzerland/epidemiology , Tomography, X-Ray Computed
9.
Eur J Cardiothorac Surg ; 58(6): 1216-1221, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-915869

ABSTRACT

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During the pandemic, several complications have been shown to be associated with coronavirus disease 2019 (COVID-19). Our goal was to present a series of patients with COVID-19 who underwent chest tube placements due to the development of pleural complications and to make suggestions for the insertion and follow-up management of the chest tube. METHODS: We retrospectively collected and analysed data on patients with laboratory-confirmed COVID-19 in our hospital between 11 March and 15 May 2020. Patients from this patient group who developed pleural complications requiring chest tube insertion were included in the study. RESULTS: A total of 542 patients who were suspected of having COVID-19 were hospitalized. The presence of severe acute respiratory syndrome coronavirus 2 was confirmed with laboratory tests in 342 patients between 11 March and 15 May 2020 in our centre. A chest tube was used in 13 (3.8%) of these patients. A high-efficiency particulate air filter mounted double-bottle technique was used to prevent viral transmission. CONCLUSIONS: In patients with COVID-19, the chest tube can be applied in cases with disease or treatment-related pleural complications. Our case series comprised a small group of patients, which is one of its limitations. Still, our main goal was to present our experience with patients with pleural complications and describe a new drainage technique to prevent viral transmission during chest tube application and follow-up.


Subject(s)
COVID-19/complications , Chest Tubes , Drainage/instrumentation , Infection Control/instrumentation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pleural Diseases/therapy , Aftercare/methods , Aged , COVID-19/epidemiology , COVID-19/therapy , COVID-19/transmission , Cross Infection/prevention & control , Cross Infection/transmission , Drainage/methods , Female , Follow-Up Studies , Humans , Infection Control/methods , Male , Middle Aged , Pandemics , Patient Safety , Pleural Diseases/virology , Retrospective Studies , Treatment Outcome , Turkey/epidemiology
11.
BMC Infect Dis ; 20(1): 437, 2020 Jun 22.
Article in English | MEDLINE | ID: covidwho-610519

ABSTRACT

BACKGROUND: The 2019 novel coronavirus (COVID-19) presents a major threat to public health and has rapidly spread worldwide since the outbreak in Wuhan, Hubei Province, China in 2019. To date, there have been few reports of the varying degrees of illness caused by the COVID-19. CASE PRESENTATION: A case of 68-year-old female with COVID-19 pneumonia who had constant pain in the right upper quadrant of her abdomen during her hospitalization that was finally diagnosed as acute cholecystitis. Ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) was performed, and the real-time fluorescence polymerase chain reaction (RT-PCR) COVID-19 nucleic acid assay of the bile was found to be negative. PTGD, antibacterial and anti-virus combined with interferon inhalation treatment were successful. CONCLUSION: The time course of chest CT findings is typical for COVID-19 pneumonia. PTGD is useful for acute cholecystitis in COVID-19 patients. Acute cholecystitis is likely to be caused by COVID-19 .


Subject(s)
Cholecystitis, Acute/complications , Coronavirus Infections/complications , Pneumonia, Viral/complications , Aged , Antiviral Agents , Betacoronavirus/physiology , COVID-19 , China , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/surgery , Coronavirus Infections/drug therapy , Disease Outbreaks , Drainage/methods , Female , Hospitalization , Humans , Pandemics , Pneumonia, Viral/drug therapy , SARS-CoV-2 , Tomography, X-Ray Computed , Ultrasonography, Interventional
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