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2.
Surg Endosc ; 36(2): 1650-1656, 2022 02.
Article in English | MEDLINE | ID: covidwho-1631982

ABSTRACT

INTRODUCTION: Elective repair versus watchful waiting remains controversial in paraesophageal hernia (PEH) patients. Generation of predictive factors to determine patients at greatest risk for emergent repair may prove helpful. The aim of this study was to evaluate patients undergoing elective versus emergent PEH repair and supplement this comparison with 3D volumetric analysis of hiatal defect area (HDA) and intrathoracic hernia sac volume (HSV) to determine risk factors for increased likelihood of emergent repair. METHODS: A retrospective review of a prospectively enrolled, single-center hernia database was performed on all patients undergoing elective and emergent PEH repairs. Patients with adequate preoperative computed tomography (CT) imaging were analyzed using volumetric analysis software. RESULTS: Of the 376 PEH patients, 32 (8.5%) were emergent. Emergent patients had lower rates of preoperative heartburn (68.8%vs85.1%, p = 0.016) and regurgitation (21.9%vs40.2%, p = 0.04), with similar rates of other symptoms. Emergent patients more frequently had type IV PEHs (43.8%vs13.5%, p < 0.001). Volumetric analysis was performed on 201 patients, and emergent patients had a larger HSV (805.6 ± 483.5vs398.0 ± 353.1cm3, p < 0.001) and HDA (41.7 ± 19.5vs26.5 ± 14.7 cm2, p < 0.001). In multivariate analysis, HSV increase of 100cm3 (OR 1.17 CI 1.02-1.35, p = 0.022) was independently associated with greater likelihood of emergent repair. Post-operatively, emergent patients had increased length of stay, major complication rates, ICU utilization, reoperation, and mortality (all p < 0.05). Emergent group recurrence rates were higher and occurred faster secondary to increased use of gastropexy alone as treatment (p > 0.05). With a formal PEH repair, there was no difference in rate or timing of recurrence. CONCLUSIONS: Emergent patients are more likely to suffer complications, require ICU care, have a higher mortality, and an increased likelihood of reoperation. A graduated increase in HSV increasingly predicts the need for an emergent operation. Those patients presenting electively with a large PEH may benefit from early elective surgery.


Subject(s)
Hernia, Hiatal , Laparoscopy , Elective Surgical Procedures/methods , Hernia, Hiatal/diagnostic imaging , Hernia, Hiatal/etiology , Hernia, Hiatal/surgery , Herniorrhaphy/methods , Humans , Laparoscopy/methods , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome
4.
Head Neck ; 42(7): 1392-1396, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1384168

ABSTRACT

The severe acute respiratory syndrome (SARS)-CoV-2 pandemic continues to produce a large number of patients with chronic respiratory failure and ventilator dependence. As such, surgeons will be called upon to perform tracheotomy for a subset of these chronically intubated patients. As seen during the SARS and the SARS-CoV-2 outbreaks, aerosol-generating procedures (AGP) have been associated with higher rates of infection of medical personnel and potential acceleration of viral dissemination throughout the medical center. Therefore, a thoughtful approach to tracheotomy (and other AGPs) is imperative and maintaining traditional management norms may be unsuitable or even potentially harmful. We sought to review the existing evidence informing best practices and then develop straightforward guidelines for tracheotomy during the SARS-CoV-2 pandemic. This communication is the product of those efforts and is based on national and international experience with the current SARS-CoV-2 pandemic and the SARS epidemic of 2002/2003.


Subject(s)
Clinical Decision-Making , Coronavirus Infections/epidemiology , Hospital Mortality/trends , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/therapy , Tracheotomy/methods , COVID-19 , Coronavirus Infections/prevention & control , Critical Care/methods , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergencies , Female , Follow-Up Studies , Humans , Intensive Care Units/statistics & numerical data , Internationality , Intubation, Intratracheal , Male , Occupational Health , Pandemics/prevention & control , Patient Safety , Pneumonia, Viral/prevention & control , Respiration, Artificial/methods , Risk Assessment , SARS Virus/pathogenicity , Survival Rate , Time Factors , Treatment Outcome , United States/epidemiology , Ventilator Weaning/methods
5.
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
8.
J Surg Oncol ; 124(7): 983-988, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1320076

ABSTRACT

BACKGROUND: The coronavirus (COVID-19) pandemic led to disruptions in operative and hospital capabilities as the country triaged resources and canceled elective procedures. This study details the operative experience of a safety-net hospital for cancer-related operations during a 3-month period at the height of the pandemic. METHODS: Patients operated on for or diagnosed with malignancies of the abdomen, breast, skin, or soft-tissue (September 3, 2020-September 6, 2020) were identified from operative/clinic schedules. Sociodemographics, tumor and treatment characteristics, and COVID-19 information was identified through retrospective chart review of a prospectively maintained database. Descriptive statistics were calculated. RESULTS: Fifty patients evaluated within this window underwent oncologic surgery. Median age was 61 (interquartile range: 53-68), 56% were female, 86% were White, and 66% were Hispanic. The majority (28%) were for colon cancer. Only two patients tested positive for COVID-19 preoperatively or within 30 days of their operation. There were no mortalities during the 1-year study period. CONCLUSION: During the COVID-19 pandemic, many hospitals and operative centers limited interventions to preserve resources, but oncologic procedures continued at many large-volume academic cancer centers. This study underscores the importance of continuing to offer surgery during the pandemic for surgical oncology cases at safety-net hospitals to minimize delays in time-sensitive oncologic treatment.


Subject(s)
COVID-19/complications , Elective Surgical Procedures/methods , Hospitals, High-Volume/statistics & numerical data , Neoplasms/surgery , SARS-CoV-2/isolation & purification , Safety-net Providers/statistics & numerical data , Aged , COVID-19/transmission , COVID-19/virology , Female , Florida/epidemiology , Humans , Male , Middle Aged , Neoplasms/epidemiology , Neoplasms/virology , Retrospective Studies , Surgical Oncology
9.
Jt Dis Relat Surg ; 32(2): 333-339, 2021.
Article in English | MEDLINE | ID: covidwho-1279004

ABSTRACT

OBJECTIVES: The aim of this study is to investigate the effect of the novel coronavirus-2019 (COVID-19) pandemic on the operational trends in the orthopedic surgery department of a tertiary referral center. PATIENTS AND METHODS: A total of 305 orthopedic surgical procedures in 245 patients (136 males, 109 females; mean age: 34±26.6 years; range, 0 to 91 years) between March 16th and June 27th, 2020 were retrospectively analyzed. The same period of the year before including 860 procedures in 783 patients (364 males, 419 females; mean age: 33.6±25.8 years; range, 0 to 95 years) was also reviewed as a pre-pandemic control group. Patient demographics, surgical indications, COVID-19 polymerase chain reaction (PCR) test status, method of anesthesia, surgical subspecialties (trauma, sports, etc.), trauma mechanisms, and surgical priorities were evaluated. The pandemic and the pre-pandemic periods were compared. RESULTS: The rate of elective surgeries decreased compared to the previous year, and priority C type surgeries had the highest frequency (42.5%). Orthopedic trauma was the leading subspecialty with 91 (29.8%) cases and had a higher share, compared to the pre-pandemic period (17.0%). Hip fractures (18.7%) were the most common cause of trauma surgery, and simple falls (42.3%) composed the largest group of trauma mechanisms, which was similar to the pre-pandemic period (hip fractures, 13.6%; simple falls, 42.5%). The distribution of surgical urgency levels and subspecialties differed significantly between the pre-pandemic and pandemic periods (p<0.001). Post-hoc analysis of subspecialty distribution revealed a significant decrease in arthroplasty (p=0.002) and hand surgery (p<0.001), and a significant increase in trauma (p<0.001) and the "other" category (p<0.001). CONCLUSION: Our experience in a tertiary referral center illustrated a shift toward performing emergent and urgent surgeries, when the severity of the outbreak increased. Prioritizing surgical urgencies during the outbreak changed the orthopedic surgery practice with an emphasis on trauma and oncology surgeries. Hip fractures were the most common cause of trauma surgery, and simple falls composed the largest group of trauma mechanisms.


Subject(s)
Anesthesia/methods , COVID-19 , Elective Surgical Procedures , Hip Fractures , Musculoskeletal Diseases , Orthopedic Procedures , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Male , Musculoskeletal Diseases/epidemiology , Musculoskeletal Diseases/etiology , Musculoskeletal Diseases/surgery , Orthopedic Procedures/methods , Orthopedic Procedures/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Turkey/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/surgery
12.
Open Heart ; 8(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1195855

ABSTRACT

BACKGROUND: The response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway. METHODS: This was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April-June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams. Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used. RESULTS: 143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period. The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors. All patients were COVID-19 PCR negative on admission with (8.1%) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8%). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms. CONCLUSION: We demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission. Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully. This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.


Subject(s)
COVID-19 , Cardiology Service, Hospital/organization & administration , Coronary Angiography/methods , Elective Surgical Procedures , Heart Valve Prosthesis Implantation/methods , Infection Control , Percutaneous Coronary Intervention/methods , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Elective Surgical Procedures/trends , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Organizational Innovation , Outcome and Process Assessment, Health Care , Risk Adjustment/methods , SARS-CoV-2 , Safety Management/organization & administration , United Kingdom/epidemiology
15.
Acta Orthop ; 92(4): 376-380, 2021 08.
Article in English | MEDLINE | ID: covidwho-1147908

ABSTRACT

Background and purpose - Many countries implemented strict lockdown policies to control the COVID-19 pandemic during March 2020. The impacts of lockdown policies on joint surgeries are unknown. Therefore, we assessed the effects of COVID-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries, and explored whether these procedures are more/less affected by lockdown restrictions than other hospital care.Patients and methods - In 1,344,355 persons aged ≥ 35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having (1) emergency surgeries due to hip fractures, and (2) electively planned surgeries due to hip osteoarthritis before and after COVID-19 lockdown restrictions were implemented nationally on March 13, 2020, for different age and sex groups. Incidence rate ratios (IRR) reflect the after-lockdown number of surgeries divided by the before-lockdown number of surgeries.Results - After-lockdown elective hip surgeries comprised one-third the number of before-lockdown (IRR ∼0.3), which is a greater drop than that seen in all-cause elective hospital care (IRR ∼0.6). Men aged 35-69 had half the number of emergency hip fracture surgeries (IRR ∼0.6), whereas women aged ≥ 70 had the same number of emergency hip fracture surgeries after lockdown (IRR ∼1). Only women aged 35-69 and men aged ≥ 70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ∼0.80)Interpretation - It is important to note for future pandemics management that lockdown restrictions may impact more on scheduled joint surgery than other scheduled hospital care. Lockdown may also impact the number of emergency joint surgeries for men aged ≥ 35 but not those for women aged ≥ 70.


Subject(s)
COVID-19 , Communicable Disease Control , Elective Surgical Procedures , Emergency Medical Services , Hip Fractures , Osteoarthritis, Hip , Age Factors , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Civil Defense/statistics & numerical data , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Hip Fractures/epidemiology , Hip Fractures/surgery , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Norway/epidemiology , Osteoarthritis, Hip/epidemiology , Osteoarthritis, Hip/surgery , Registries/statistics & numerical data , SARS-CoV-2 , Sex Factors
16.
BMC Anesthesiol ; 20(1): 232, 2020 09 14.
Article in English | MEDLINE | ID: covidwho-757603

ABSTRACT

BACKGROUND: The challenges posed by the spread of COVID-19 disease through aerosols have compelled anesthesiologists to modify their airway management practices. Devices such as barrier boxes are being considered as potential adjuncts to full PPE's to limit the aerosol spread. Usage of the barrier box raises concerns of delay in time to intubate (TTI). We designed our study to determine if using a barrier box with glidescope delays TTI within acceptable parameters to make relevant clinical conclusions. METHODS: Seventy-eight patients were enrolled in this prospective non-inferiority controlled trial and were randomly allocated to either group C (without the barrier box) or the study group BB (using barrier box). The primary measured endpoint is time to intubate (TTI), which is defined as time taken from loss of twitches confirmed with a peripheral nerve stimulator to confirmation of end-tidal CO 2. 15 s was used as non-inferiority margin for the purpose of the study. We used an unpaired two-sample single-sided t-test to test our non- inferiority hypothesis (H 0: Mean TTI diff ≥15 s, H A: Mean TTI diff < 15 s). Secondary endpoints include the number of attempts at intubation, lowest oxygen saturation during induction, and the need for bag-mask ventilation. RESULTS: Mean TTI in group C was 42 s (CI 19.2 to 64.8) vs. 52.1 s (CI 26.1 to 78) in group BB. The difference in mean TTI was 10.1 s (CI -∞ to 14.9). We rejected the null hypothesis and concluded with 95% confidence that the difference of the mean TTI between the groups is less than < 15 s (95% CI -∞ to 14.9,p = 0.0461). Our induction times were comparable (67.7 vs. 65.9 s).100% of our patients were intubated on the first attempt in both groups. None of our patients needed rescue breaths. CONCLUSIONS: We conclude that in patients with normal airway exam, scheduled for elective surgeries, our barrier box did not cause any clinically significant delay in TTI when airway manipulation is performed by well-trained providers. The study was retrospectively registered at clinicaltrials.gov (NCT04411056) on May 27, 2020.


Subject(s)
Airway Management/methods , Anesthesiology/methods , Coronavirus Infections/therapy , Intubation, Intratracheal/methods , Pneumonia, Viral/therapy , Adult , Aerosols , Aged , Airway Management/instrumentation , Anesthesiologists/organization & administration , Anesthesiology/instrumentation , COVID-19 , Coronavirus Infections/prevention & control , Elective Surgical Procedures/methods , Female , Humans , Intubation, Intratracheal/instrumentation , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Prospective Studies , Respiration, Artificial/methods , Time Factors
17.
In Vivo ; 35(2): 1299-1305, 2021.
Article in English | MEDLINE | ID: covidwho-1100488

ABSTRACT

BACKGROUND/AIM: A notable re-allocation of healthcare resources and specific clinical and organizational measures have been required to prevent COVID-19 infection among hospitalized patients and healthcare workers. PATIENTS AND METHODS: From March 9th to May 9th 2020 we performed colorectal cancer elective surgery on 25 patients: a pre-hospital screening was carried out in order to avoid hospitalization of patients suspected of COVID-19 infection. RESULTS: All patients (median age=76 years; range=37-88 years) were considered suitable for admission after telephone triage; the median interval between primary diagnosis and hospital admission was 23.1 days (range=1-55 days). The median hospitalization was 7.8 days (range=4-18 days). One COVID-19-associated death was reported. CONCLUSION: Our experience demonstrates that safe colorectal cancer elective surgery can be performed during the pandemic COVID-19. Further consensus and guidelines to prevent diffusion of pandemic diseases among hospitalized patients and healthcare workers still need to be implemented.


Subject(s)
COVID-19/prevention & control , Colorectal Neoplasms/surgery , Elective Surgical Procedures/methods , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Female , Hospitalization/statistics & numerical data , Humans , Male , Medical Oncology/methods , Middle Aged , Pandemics , SARS-CoV-2/physiology
19.
J Surg Oncol ; 123(7): 1495-1503, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1095651

ABSTRACT

BACKGROUND: We aimed to assess the feasibility and short-term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID-19)-free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. MATERIALS AND METHODS: This was a single-center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS-CoV-2 infection and 30-day pulmonary or non-pulmonary related morbidity and mortality associated with SARS-CoV-2 disease. RESULTS: Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS-CoV2 infection because of acute respiratory distress syndrome. The overall non-SARS-CoV2 related 30-day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS-CoV2 related 30-day morbidity and mortality rates were 0.2% and 0.2%, respectively. CONCLUSIONS: Under strict institutional policies and measures to establish a COVID-19-free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.


Subject(s)
COVID-19/epidemiology , Elective Surgical Procedures/statistics & numerical data , Neoplasms/surgery , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Elective Surgical Procedures/methods , Elective Surgical Procedures/mortality , Female , Humans , Male , Middle Aged , Neoplasms/mortality , Pandemics , Postoperative Complications/virology , Retrospective Studies , SARS-CoV-2/isolation & purification , Turkey/epidemiology , Young Adult
20.
Aust Health Rev ; 44(5): 723-727, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1084111

ABSTRACT

Objective This study analysed screening for COVID-19 before surgery and outcomes of any perioperative testing for SARS-CoV-2 infection during pandemic-restricted surgery. Methods An audit was conducted with routinely collected health data before both elective and non-elective surgery at two large Melbourne hospitals during April and early May 2020. We looked for documented systematic screening for COVID-19 disease and fever (>38°C) and results of SARS-COV-2 testing, and proposed a minimum acceptable documenting rate of 85%. Results The study included 2197 consecutive patients (1279 (58%) undergoing elective surgery, 917 (42%) undergoing non-elective surgery) across most specialities. Although 926 (72%) patients undergoing elective surgery had both systematic screening and temperature documented, approximately half that percentage undergoing non-elective surgery (n=347; 38%) had both documented. However, 871 (95%) of non-elective surgery patients had temperature documented. Acknowledging limited screening, 85 (9.3%) non-elective surgery patients had positive screening, compared with 39 (3.0%) elective surgery patients. All 152 (7%) patients who were tested for SARS-CoV-2 were negative, and no cases were reported from external contact tracing. Conclusions Although 'not documented' does not necessarily equal 'not done', we found that documenting of COVID-19 screening could be improved. Better understanding of implementing screening practices in pandemics and other crises, particularly for non-elective surgery patients, is warranted. What is known about the topic? Little is known about routine screening for SARS-CoV-2 infection among surgical patients. However, it is well established that implementing effective uptake of safety and quality initiatives can be difficult. What does this paper add? We found that although most patients had documented temperature, fewer than 75% had a documented systematic questionnaire screen for COVID, particularly patients undergoing non-elective surgery. What are the implications for practitioners? Clear documenting is important in managing patients. Pandemics and other crises can require rapid changes in practice. Implementing such measures may be less complete than anticipated and may require greater use of evidence-based implementation strategies, particularly in the less predictable care of non-elective surgery patients.


Subject(s)
Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Data Collection/methods , Elective Surgical Procedures/methods , Mass Screening/methods , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Preoperative Care/methods , Adult , Aged , Aged, 80 and over , Australia , Betacoronavirus/pathogenicity , COVID-19 , COVID-19 Testing , Humans , Male , Middle Aged , SARS-CoV-2
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