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1.
Ann Ital Chir ; 93: 599-605, 2022.
Article in English | MEDLINE | ID: covidwho-2073042

ABSTRACT

AIM OF THE STUDY: This study presents the impact of the Covid-19 pandemic on elective surgical treatment of patients diagnosed with colon cancer, in a University Clinic of Surgery. MATERIAL AND METHODS: The data from patients who underwent an elective surgery procedure for colon cancer during the pandemic period (26.02.2020-01.10.2021) was analyzed. This period was compared with the same interval for the years 2016-2017 and 2018-2019. RESULTS: There was a significant decrease in the number of patients that underwent an elective surgery for colon cancer during the pandemic. The Covid-19 generated pandemic has influenced the number of days from diagnosis to treatment, preoperative and postoperative hospitalization. There was an increase in the number of patients with severe symptoms, with complete or incomplete ileus. The number of lymphatic nodes harvested increased during the last period of study, being correlated with the advanced cancer stage. CONCLUSIONS: The Covid-19 pandemic had an influence on the management of the patients with colon cancer undergoing an elective surgery procedure. Firstly, their number decreased compared to the other periods, and they presented more severe symptoms. The duration of the surgical act was extended, but the postoperative stay was shortened. KEY WORDS: Colon cancer, Covid-19 Pandemic, Duration of surgery, Elective surgery.


Subject(s)
COVID-19 , Colonic Neoplasms , Ileus , COVID-19/epidemiology , Colonic Neoplasms/surgery , Elective Surgical Procedures/adverse effects , Humans , Ileus/etiology , Pandemics
2.
Ann Surg ; 276(6): 969-974, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2037601

ABSTRACT

OBJECTIVE: To investigate the predictors of postoperative mortality in coronavirus disease 2019 (COVID-19)-positive patients. BACKGROUND: COVID-19-positive patients have more postoperative complications. Studies investigating the risk factors for postoperative mortality in COVID-19-positive patients are limited. METHODS: COVID-19-positive patients who underwent surgeries/procedures in Cleveland Clinic between January 2020 and March 2021 were identified retrospectively. The primary outcome was postoperative/procedural 30-day mortality. Secondary outcomes were length of stay, intensive care unit admission, and 30-day readmission. RESULTS: A total of 2543 patients who underwent 3027 surgeries/procedures were included. Total 48.5% of the patients were male. The mean age was 57.8 (18.3) years. A total of 71.2% had at least 1 comorbidity. Total 78.7% of the cases were elective. The median operative time was 94 (47.0-162) minutes and mean length of stay was 6.43 (13.4) days. Postoperative/procedural mortality rate was 4.01%. Increased age [odds ratio (OR): 1.66, 95% CI, 1.4-1.98; P <0.001], being a current smoker [2.76, (1.3-5.82); P =0.008], presence of comorbidity [3.22, (1.03-10.03); P =0.043], emergency [6.35, (3.39-11.89); P <0.001] and urgent versus [1.78, (1.12-2.84); P =0.015] elective surgery, admission through the emergency department [15.97, (2.00-127.31); P =0.009], or inpatient service [32.28, (7.75-134.46); P <0.001] versus outpatients were associated with mortality in the multivariable analysis. Among all specialties, thoracic surgery [3.76, (1.66-8.53); P =0.002] had the highest association with mortality. Total 17.5% of the patients required intensive care unit admission with increased body mass index being a predictor [1.03, (1.01-1.05); P =0.005]. CONCLUSIONS: COVID-19-positive patients have higher risk of postintervention mortality. Risk factors should be carefully evaluated before intervention. Further studies are needed to understand the impact of pandemic on long-term surgical/procedural outcomes.


Subject(s)
COVID-19 , Humans , Male , Middle Aged , Female , Retrospective Studies , Pandemics , Risk Factors , Elective Surgical Procedures/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology
3.
Ann Ital Chir ; 93: 599-605, 2022.
Article in English | MEDLINE | ID: covidwho-2011343

ABSTRACT

AIM OF THE STUDY: This study presents the impact of the Covid-19 pandemic on elective surgical treatment of patients diagnosed with colon cancer, in a University Clinic of Surgery. MATERIAL AND METHODS: The data from patients who underwent an elective surgery procedure for colon cancer during the pandemic period (26.02.2020-01.10.2021) was analyzed. This period was compared with the same interval for the years 2016-2017 and 2018-2019. RESULTS: There was a significant decrease in the number of patients that underwent an elective surgery for colon cancer during the pandemic. The Covid-19 generated pandemic has influenced the number of days from diagnosis to treatment, preoperative and postoperative hospitalization. There was an increase in the number of patients with severe symptoms, with complete or incomplete ileus. The number of lymphatic nodes harvested increased during the last period of study, being correlated with the advanced cancer stage. CONCLUSIONS: The Covid-19 pandemic had an influence on the management of the patients with colon cancer undergoing an elective surgery procedure. Firstly, their number decreased compared to the other periods, and they presented more severe symptoms. The duration of the surgical act was extended, but the postoperative stay was shortened. KEY WORDS: Colon cancer, Covid-19 Pandemic, Duration of surgery, Elective surgery.


Subject(s)
COVID-19 , Colonic Neoplasms , Ileus , COVID-19/epidemiology , Colonic Neoplasms/surgery , Elective Surgical Procedures/adverse effects , Humans , Ileus/etiology , Pandemics
4.
World J Surg ; 46(10): 2288-2296, 2022 10.
Article in English | MEDLINE | ID: covidwho-1990612

ABSTRACT

BACKGROUND: The aim of this study was to investigate how the COVID-19 pandemic influenced ERAS program application in colorectal surgery across hospitals in the Lazio region (central district in Italy) participating in the "Lazio Network" project. METHODS: A multi-institutional database was constructed. All patients included in this study underwent elective colorectal surgery for both malignant and benign disease between January 2019 and December 2020. Emergency procedures were excluded. The population was divided into 2 groups: a pre-COVID-19 group (PG) of patients operated on between February and December 2019 and a COVID-19 group (CG) of patients operated on between February and December 2020, during the first 2 waves of the pandemic in Italy. RESULTS: The groups included 622 patients in the PG and 615 in the CG treated in 8 hospitals of the network. The mean number of items applied was higher in the PG (65.6% vs. 56.6%, p < 0.001) in terms of preoperative items (64.2% vs. 50.7%, p < 0.001), intraoperative items (65.0% vs. 53.3%, p < 0.001), and postoperative items (68.8% vs. 63.2%, p < 0.001). Postoperative recovery was faster in the PG, with a shorter time to first flatus, first stool, autonomous mobilization and discharge (6.82 days vs. 7.43 days, p = 0.021). Postoperative complications, mortality and reoperations were similar among the groups. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the application of ERAS in the centers of the "Lazio Network" study group, with a reduction in adherence to the ERAS protocol in terms of preoperative, intraoperative and postoperative items. In addition, in the CG, the patients had worse postoperative outcomes with respect to recovery and discharge.


Subject(s)
COVID-19 , Enhanced Recovery After Surgery , COVID-19/epidemiology , Elective Surgical Procedures/adverse effects , Humans , Length of Stay , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/etiology
5.
Am Surg ; 88(10): 2572-2578, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1909979

ABSTRACT

PURPOSE: Enhanced recovery pathways (ERPs) are associated with reduced complications and length of stay. The validation of the I-FEED scoring system, advances in perioperative anesthesia, multimodal analgesia, and telehealth remote monitoring have resulted in further evolution of ERPs setting the stage for same day discharge (SDD). Pioneers and early adopters have demonstrated the safety and feasibility of SDD programs. The aim of this study is to evaluate the impact of a pilot SDD ERP on patient self-reported pain scoring and narcotic usage. METHODS: A quality improvement pilot program was conducted to assess the impact of a SDD ERP on post-operative pain score reporting and opioid use in healthy patients undergoing elective colorectal surgery as an alternative to post-operative hospitalization during the COVID-19 pandemic (May 2020-December 2021). Patients were monitored remotely with daily telephone visits on POD 1-7 assessing the following variables: I-FEED score, pain score, pain management, bowel function, dietary advancement, any complications, and/or re-admissions. RESULTS: Thirty-seven patients met the highly selective eligibility criteria for "healthy patient, healthy anastomosis." SDD occurred in 70%. The remaining 30% were discharged on POD 1. Mean total narcotic usage was 5.2 tablets of 5 mg oxycodone despite relatively high reported pain scores. CONCLUSIONS: In our initial experience, SDD is associated with significantly lower patient narcotic utilization for postoperative pain management than hypothesized. This pilot SDD program resulted in a change in clinical practice with reduction of prescribed discharge oxycodone 5 mg quantity from #40 to #10 tablets.


Subject(s)
COVID-19 , Colorectal Neoplasms , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Colorectal Neoplasms/drug therapy , Elective Surgical Procedures/adverse effects , Humans , Minimally Invasive Surgical Procedures/adverse effects , Narcotics , Opioid-Related Disorders/complications , Oxycodone , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pandemics , Patient Discharge , Retrospective Studies
6.
Clinics (Sao Paulo) ; 76: e2507, 2021.
Article in English | MEDLINE | ID: covidwho-1870057

ABSTRACT

OBJECTIVES: Since the outbreak of the novel coronavirus disease 2019 (COVID-19), all health services worldwide underwent profound changes, leading to the suspension of many elective surgeries. This study aimed to evaluate the safety of elective colorectal surgery during the pandemic. METHODS: This was a retrospective, cross-sectional, single-center study. Patients who underwent elective colorectal surgery during the COVID-19 pandemic between March 10 and September 9, 2020, were included. Patient data on sex, age, diagnosis, types of procedures, hospital stay, mortality, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperative screening tests were recorded. RESULTS: A total of 103 colorectal surgical procedures were planned, and 99 were performed. Four surgeries were postponed due to positive preoperative screening for SARS-CoV-2. Surgical procedures were performed for colorectal cancer (n=90) and inflammatory bowel disease (n=9). Laparoscopy was the approach of choice for 43 patients (43.4%), 53 (53.5%) procedures were open, and 3 (3%) procedures were robotic. Five patients developed COVID-19 in the postoperative period, and three of them died in the intensive care unit (n=3/5, 60% mortality). Two other patients died due to surgical complications unrelated to COVID-19 (n=2/94, 2.1% mortality) (p<0.01). Hospital stay was longer in patients with SARS-CoV-2 infection than in those without (38.4 versushttps://doi.org/10.3 days, respectively, p<0.01). Of the 99 patients who received surgical care during the pandemic, 94 were safely discharged (95%). CONCLUSION: Our study demonstrated that elective colorectal surgical procedures may be safely performed during the pandemic; however, preoperative testing should be performed to reduce in-hospital infection rates, since the mortality rate due to SARS-CoV-2 in this setting is particularly high.


Subject(s)
COVID-19 , Colorectal Neoplasms , Colorectal Surgery , Cross-Sectional Studies , Elective Surgical Procedures/adverse effects , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
7.
Surgery ; 172(3): 989-996, 2022 09.
Article in English | MEDLINE | ID: covidwho-1852108

ABSTRACT

BACKGROUND: Optimal inguinal hernia repair timing remains controversial. It remains unclear how COVID-19 related elective surgery cancellations impacted timing of inguinal hernia repair and whether any delays led to complications. This study aims to determine whether elective surgery cancellations are safe in pediatric inguinal hernia. METHODS: This multicenter retrospective cohort study at 14 children's hospitals included patients ≤18 years who underwent inguinal hernia repair between September 13, 2019, through September 13, 2020. Patients were categorized by whether their inguinal hernia repair occurred before or after their hospital's COVID-19 elective surgery cancellation date. Incarceration and emergency department encounters were compared between pre and postcancellation. RESULTS: Of 1,404 patients, 604 (43.0%) underwent inguinal hernia repair during the postcancellation period, 92 (6.6%) experienced incarceration, and 213 (15.2%) had an emergency department encounter. The postcancellation period was not associated with incarceration (odds ratio 1.54; 95% confidence interval 0.88-2.71; P = .13) or emergency department encounters (odds ratio 1.53; 95% confidence interval 0.94-2.48; P = .09) despite longer median times to inguinal hernia repair (precancellation 29 days [interquartile range 13-55 days] versus postcancellation 31 days [interquartile range 14-73 days], P = .01). Infants were more likely to have the emergency department be their index presentation in the postcancellation period (odds ratio 1.69; 95% confidence interval 1.24-2.31; P < .01). CONCLUSION: Overall, COVID-19 elective surgery cancellations do not appear to increase the likelihood of incarceration or emergency department encounters despite delays in inguinal hernia repair, suggesting that cancellations are safe in children with inguinal hernia. Assessment of elective surgery cancellation safety has important implications for health policy.


Subject(s)
COVID-19 , Hernia, Inguinal , COVID-19/epidemiology , Child , Cohort Studies , Elective Surgical Procedures/adverse effects , Hernia, Inguinal/complications , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Humans , Infant , Retrospective Studies
8.
J Arthroplasty ; 37(10): 2106-2113.e1, 2022 10.
Article in English | MEDLINE | ID: covidwho-1821138

ABSTRACT

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has caused a substantial number of patients to have their elective arthroplasty surgeries rescheduled. While it is established that patients with COVID-19 who are undergoing surgery have a significantly higher risk of experiencing postoperative complications and mortality, it is not well-known at what time after testing positive the risk of postoperative complications or mortality returns to normal. METHODS: PubMed (MEDLINE), Excerpta Medica dataBASE, and professional society websites were systematically reviewed on March 7, 2022 to identify studies and guidelines on the optimal timeframe to reschedule patients for elective surgery after preoperatively testing positive for COVID-19. Outcomes included postoperative complications such as mortality, pneumonia, acute respiratory distress syndrome, septic shock, and pulmonary embolism. RESULTS: A total of 14 studies and professional society guidelines met the inclusion criteria for this systematic review. Patients with asymptomatic COVID-19 should be rescheduled 4-8 weeks after testing positive (as long as they do not develop symptoms in the interim), patients with mild/moderate COVID-19 should be rescheduled 6-8 weeks after testing positive (with complete resolution of symptoms), and patients with severe/critical COVID-19 should be rescheduled at a minimum of 12 weeks after hospital discharge (with complete resolution of symptoms). CONCLUSIONS: Given the negative association between preoperative COVID-19 and postoperative complications, patients should have elective arthroplasty surgery rescheduled at differing timeframes based on their symptoms. In addition, a multidisciplinary and patient-centered approach to rescheduling patients is recommended. Further study is needed to examine the impact of novel COVID-19 variants and vaccination on timeframes for rescheduling surgery.


Subject(s)
COVID-19 , Arthroplasty , COVID-19/epidemiology , Elective Surgical Procedures/adverse effects , Humans , Postoperative Complications/epidemiology , Postoperative Complications/etiology , SARS-CoV-2
9.
Langenbecks Arch Surg ; 407(4): 1315-1332, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1750709

ABSTRACT

Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.


Subject(s)
COVID-19 , Critical Care , Elective Surgical Procedures/adverse effects , Humans , Pandemics , SARS-CoV-2
10.
Sci Rep ; 12(1): 1349, 2022 01 25.
Article in English | MEDLINE | ID: covidwho-1661975

ABSTRACT

Irrespective of its etiology, emergency surgical abdominal exploration (EAE) is considered a high-risk procedure with mortality rates exceeding 20%. The aim of this study was to evaluate differences in outcomes in patients who required EAE due to complications of complex elective abdominal procedures and those who required EAE due to high-risk primary abdominal emergencies. Patients undergoing EAE for acute surgical complications of complex abdominal elective surgical procedures (N = 293; Elective group) and patients undergoing EAE for high-risk primary abdominal emergencies (N = 776; Emergency group) from 2012 to 2019 at our institution were retrospectively assessed for morbidity and mortality. Postoperative complications occurred in 196 patients (66.94%) in the elective group and 585 patients (75.4%) in the emergency group. The relatively low complication burden in the elective group was also evidenced by a significantly lower comprehensive complication index score (54.00 ± 37.36 vs. 59.25 ± 37.08, p = 0.040). The in-hospital mortality rates were 31% (91 of 293) and 38% (295 of 776) in the elective and emergency groups, respectively. This difference between the two groups was statistically significant (p = 0.035). In multivariate analysis, age, peripheral artery disease, pneumonia, thromboembolic events, ICU stay, ventilator dependence, acute kidney failure and liver failure were independent predictors of mortality. Our data show that patients undergoing EAE due to acute complications of major elective surgery tolerate the procedure relatively well compared with patients undergoing EAE due to primary high-risk abdominal emergencies.


Subject(s)
Abdomen/surgery , Elective Surgical Procedures/adverse effects , Laparotomy/adverse effects , Postoperative Complications , Aged , Female , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies
11.
Ann Surg ; 275(2): 247-251, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1522451

ABSTRACT

OBJECTIVE: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA. BACKGROUND: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists. METHODS: As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality. RESULTS: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]). CONCLUSIONS: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.


Subject(s)
COVID-19/diagnosis , Elective Surgical Procedures/adverse effects , Postoperative Complications/diagnosis , Age Factors , Aged , Female , Humans , Male , Middle Aged , Pneumonia/diagnosis , Prospective Studies , Respiratory Distress Syndrome/diagnosis , Risk Factors , SARS-CoV-2 , Sex Factors , Time-to-Treatment , United States
12.
Ann Surg ; 275(2): 242-246, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1522450

ABSTRACT

OBJECTIVE: To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications. SUMMARY BACKGROUND DATA: It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications. METHODS: The risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 ("pre-Covid-19"), (2) 0 to 4 weeks after SARS-CoV-2 infection ("peri-Covid-19"), (3) 4 to 8 weeks after infection ("early post-Covid-19"), and (4) ≥8 weeks after infection ("late post-Covid-19"). RESULTS: Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients. CONCLUSIONS: Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.


Subject(s)
COVID-19/diagnosis , Elective Surgical Procedures/adverse effects , Postoperative Complications/diagnosis , Time-to-Treatment , COVID-19 Testing , Humans , Pneumonia/diagnosis , Pulmonary Embolism/diagnosis , Respiratory Insufficiency/diagnosis , Risk Factors , SARS-CoV-2 , Sepsis/diagnosis , United States
14.
Br J Surg ; 107(13): 1708-1712, 2020 12.
Article in English | MEDLINE | ID: covidwho-1384126

ABSTRACT

This study used a national administrative database to estimate perioperative SARS-CoV-2 infection risk, and associated mortality, relative to nosocomial transmission rates. The impact of nosocomial transmission was greatest after major emergency surgery, whereas laparoscopic surgery may be protective owing to reduced duration of hospital stay. Procedure-specific risk estimates are provided to facilitate surgical decision-making and informed consent. Estimated risks.


Subject(s)
Coronavirus Infections/epidemiology , Cross Infection/transmission , Elective Surgical Procedures/adverse effects , Infection Control/methods , Length of Stay/statistics & numerical data , Pneumonia, Viral/epidemiology , Surgical Wound Infection/mortality , COVID-19 , Cause of Death , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Databases, Factual , Elective Surgical Procedures/methods , Emergencies , Female , Humans , Incidence , Male , Pandemics/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/prevention & control , Prognosis , Risk Assessment , Surgical Wound Infection/prevention & control , Survival Analysis
15.
J Endocrinol Invest ; 45(1): 181-188, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1317607

ABSTRACT

PURPOSE: During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. METHODS: We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ''Thyroid'' and "coronavirus" as search terms. RESULTS: Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2-3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. CONCLUSION: The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.


Subject(s)
COVID-19/epidemiology , Elective Surgical Procedures/adverse effects , Postoperative Complications/epidemiology , SARS-CoV-2 , Thyroid Diseases/epidemiology , Thyroid Diseases/surgery , Adult , Aged , Aged, 80 and over , Comorbidity , Cross Infection/epidemiology , Female , Humans , Hypoparathyroidism/epidemiology , Laryngeal Nerve Injuries/epidemiology , Lymph Node Excision/adverse effects , Male , Middle Aged , Thyroid Neoplasms/surgery , Thyroidectomy/adverse effects
16.
JSLS ; 25(2)2021.
Article in English | MEDLINE | ID: covidwho-1305863

ABSTRACT

BACKGROUND AND OBJECTIVES: Operating-room procedures canceled due to the COVID-19 pandemic depleted hospital revenue and potentially worsened patient outcomes through disease progression. Despite safeguards to resume elective procedures, patients remain apprehensive of contracting COVID-19 during hospitalization and recovery. We investigated symptomatic COVID-19 infection in patients undergoing operating-room procedures during the spring 2020 outbreak in Fairfield County, CT, a heavily affected New York Metropolitan area. METHODS: We retrospectively analyzed 419 operating-room patients in Danbury and Norwalk Hospitals between 3/16/20 and 5/19/20. COVID-19 infection was assessed through test results or documented well-being within 2 weeks postdischarge. Variables studied were procedure classification, length of stay, and discharge disposition. Postprocedural COVID-19 infection was analyzed using binomial tests comparing rates to state-mandated infection data. RESULTS: Six patients developed COVID-19 after 212 urgent-elective and 207 emergent procedures. Overall postprocedural infection risk was equivalent to community infection risk (P > .05). No infections occurred in 1-2 day stays or urgent-elective procedures with discharge home (both P < .05). Discharges home reduced the risk to one-sixth of community spread (P = .03). Risk of infection doubled in hospitalizations > 5 days (P = .05) and quadrupled in discharges to extended care facilities (P = .01). DISCUSSION: Operating-room procedures did not increase the risk of symptomatic COVID-19 infection during an outbreak. Urgent-elective and emergent procedures during further outbreaks appear safe when anticipating short stays with discharges home. When anticipating prolonged hospitalization or discharges to facilities, appropriate delay of urgent-elective procedures may minimize risk of infection.


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Elective Surgical Procedures/adverse effects , Patient Discharge/statistics & numerical data , Postoperative Complications/epidemiology , Aged , Aged, 80 and over , COVID-19/transmission , Connecticut/epidemiology , Cross Infection/virology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Operating Rooms , Postoperative Complications/virology , Retrospective Studies , SARS-CoV-2
17.
Ann R Coll Surg Engl ; 103(7): 524-529, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288677

ABSTRACT

INTRODUCTION: Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. METHODS: A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. RESULTS: Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41 years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. CONCLUSION: With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.


Subject(s)
Bariatric Surgery/adverse effects , COVID-19/prevention & control , Elective Surgical Procedures/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Adult , Bariatric Surgery/standards , Bariatric Surgery/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , Clinical Protocols/standards , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Enhanced Recovery After Surgery/standards , Feasibility Studies , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Postoperative Complications/etiology , Prospective Studies , Retrospective Studies , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/organization & administration , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
18.
J Am Coll Surg ; 233(3): 435-444.e1, 2021 09.
Article in English | MEDLINE | ID: covidwho-1260777

ABSTRACT

BACKGROUND: High scores in the Medically Necessary, Time-Sensitive (MeNTS) scoring system, used for elective surgical prioritization during the coronavirus disease 2019 pandemic, are assumed to be associated with worse outcomes. We aimed to evaluate the MeNTS scoring system in patients undergoing elective surgery during restricted capacity of our institution, with or without moderate or severe postoperative complications. STUDY DESIGN: In this prospective observational study, MeNTS scores of patients undergoing elective operations during May and June 2020 were calculated. Postoperative complication severity (classified as Group Clavien-Dindo < II or Group Clavien-Dindo ≥ II), as well as Duke Activity Index, American Society of Anesthesiologists (ASA) physical status, presence of smoking, leukocytosis, lymphopenia, elevated C-reactive protein (CRP), operation and anesthesia characteristics, intensive care requirement and duration, length of hospital stay, rehospitalization, and mortality were noted. RESULTS: There were 223 patients analyzed. MeNTS score was higher in the Clavien-Dindo ≥ II Group compared with the Clavien-Dindo < II Group (50.98 ± 8.98 vs 44.27 ± 8.90 respectively, p < 0.001). Duke activity status index (DASI) scores were lower, and American Society of Anesthesiologists physical status class, presence of smoking, leukocytosis, lymphopenia, elevated CRP, and intensive care requirement were higher in the Clavien-Dindo ≥ II Group (p < 0.01). Length of hospital stay was longer in the Clavien-Dindo ≥ II Group (15 [range 2-90] vs 4 [1-30] days; p < 0.001). Mortality was observed in 8 patients. Area under the receiver operating characteristic curve of MeNTS and DASI were 0.69 and 0.71, respectively, for predicting moderate/severe complications. CONCLUSIONS: Although significant, MeNTS score had low discriminating power in distinguishing patients with moderate/severe complications. Incorporation of a cardiovascular functional capacity measure could improve the scoring system.


Subject(s)
COVID-19/epidemiology , Elective Surgical Procedures/adverse effects , Pandemics , Postoperative Complications/classification , Triage/methods , Anesthesia , C-Reactive Protein/analysis , COVID-19/diagnosis , Critical Care , Elective Surgical Procedures/classification , Elective Surgical Procedures/mortality , Female , Health Priorities , Humans , Length of Stay , Leukocytosis/diagnosis , Lymphopenia/diagnosis , Male , Middle Aged , Patient Readmission , Physical Functional Performance , Postoperative Complications/mortality , Prospective Studies , Sensitivity and Specificity , Severity of Illness Index , Smoking , Treatment Outcome , Turkey
19.
Am J Surg ; 223(2): 380-387, 2022 02.
Article in English | MEDLINE | ID: covidwho-1198601

ABSTRACT

BACKGROUND: The COVID-19 pandemic has necessitated the adoption of protocols to minimize risk of periprocedural complications associated with SARS-CoV-2 infection. This typically involves a preoperative symptom screen and nasal swab RT-PCR test for viral RNA. Asymptomatic patients with a negative COVID-19 test are cleared for surgery. However, little is known about the rate of postoperative COVID-19 positivity among elective surgical patients, risk factors for this group and rate of complications. METHODS: This prospective multicenter study included all patients undergoing elective surgery at 170 Veterans Health Administration (VA) hospitals across the United States. Patients were divided into groups based on first positive COVID-19 test within 30 days after surgery (COVID[-/+]), before surgery (COVID[+/-]) or negative throughout (COVID[-/-]). The cumulative incidence, risk factors for and complications of COVID[-/+], were estimated using univariate analysis, exact matching, and multivariable regression. RESULTS: Between March 1 and December 1, 2020 90,093 patients underwent elective surgery. Of these, 60,853 met inclusion criteria, of which 310 (0.5%) were in the COVID[-/+] group. Adjusted multivariable logistic regression identified female sex, end stage renal disease, chronic obstructive pulmonary disease, congestive heart failure, cancer, cirrhosis, and undergoing neurosurgical procedures as risk factors for being in the COVID[-/+] group. After matching on current procedural terminology code and month of procedure, multivariable Poisson regression estimated the complication rate ratio for the COVID[-/+] group vs. COVID[-/-] to be 8.4 (C.I. 4.9-14.4) for pulmonary complications, 3.0 (2.2, 4.1) for major complications, and 2.6 (1.9, 3.4) for any complication. DISCUSSION: Despite preoperative COVID-19 screening, there remains a risk of COVID infection within 30 days after elective surgery. This risk is increased for patients with a high comorbidity burden and those undergoing neurosurgical procedures. Higher intensity preoperative screening and closer postoperative monitoring is warranted in such patients because they have a significantly elevated risk of postoperative complications.


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19/epidemiology , Elective Surgical Procedures/adverse effects , Mass Screening/statistics & numerical data , Postoperative Complications/epidemiology , Adult , COVID-19/complications , COVID-19/immunology , COVID-19/virology , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/immunology , Postoperative Period , Preoperative Period , Prospective Studies , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , United States/epidemiology
20.
Br J Surg ; 108(1): 88-96, 2021 01 27.
Article in English | MEDLINE | ID: covidwho-1112088

ABSTRACT

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Elective Surgical Procedures/adverse effects , Lung Diseases/etiology , Nasopharynx/virology , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Neoplasms/surgery , Pandemics , Postoperative Complications , Risk Assessment , SARS-CoV-2
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